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Title: Director of Quality Improvement / Clinical Performance
Reports to: Chief Medical Officer
Position Overview: The Director of Quality Improvement / Clinical Performance will be responsible for leading and overseeing the development, implementation, and management of quality improvement (QI) initiatives within the South Side Healthy Community Organization and Partner Organizations. This role will focus on optimizing clinical performance, improving patient outcomes, ensuring compliance with quality standards, and supporting value-based care models aimed at achieving cost-effective, patient-centered care. The Director will collaborate with key stakeholders, including clinical teams, leadership, data analysts, and external partners, to enhance the organization's clinical performance and drive quality outcomes in alignment with value-based care objectives.
Key Responsibilities
Leadership and Strategy Development:
Lead the development and execution of the organization’s quality improvement and clinical performance strategy in a value-based care environment.
Drive the implementation of clinical initiatives aimed at improving patient outcomes, reducing readmissions, and lowering overall healthcare costs.
Establish quality improvement goals, metrics, and benchmarks aligned with industry standards, value-based care agreements, and regulatory requirements.
Provide leadership to the QI and clinical performance teams, promoting collaboration across departments to ensure cohesive and effective care management.
Quality Improvement Program Oversight:
Design, implement, and continuously evaluate quality improvement programs and initiatives to drive improvements in care delivery and outcomes.
Ensure ongoing monitoring and reporting of performance data to assess the effectiveness of quality improvement efforts.
Identify areas for improvement based on performance data, patient feedback, clinical audits, and outcome measures, and implement targeted interventions.
Support clinical teams in the adoption of evidence-based practices and clinical guidelines to optimize patient care and reduce variation.
Clinical Performance Analytics and Reporting:
Utilize data analytics tools to track and assess clinical performance metrics, such as HEDIS, STAR ratings, ACO quality measures, and other relevant performance indicators.
Develop actionable insights from data to improve clinical practices, patient engagement, and care coordination.
Prepare and present regular reports to senior leadership on quality improvement progress, clinical performance outcomes, and trends in value-based care.
Stakeholder Collaboration and Education:
Collaborate with physicians, clinical staff, care managers, and other healthcare professionals to implement best practices in patient care and quality management.
Provide education and training on quality improvement methodologies, value-based care principles, and clinical performance optimization.
Work with payers, providers, and other external partners to support the achievement of quality benchmarks and reimbursement targets tied to value-based contracts.
Regulatory Compliance and Accreditation:
Ensure compliance with federal and state regulations, accreditation standards (e.g., NCQA, URAC), and payer contract requirements related to quality and performance measures.
Lead the organization’s preparation for audits and reviews related to clinical quality, ensuring all documentation and processes meet necessary standards.
Innovation and Continuous Improvement:
Stay current with industry trends, regulatory changes, and emerging technologies in value-based care and quality improvement.
Lead or support the implementation of innovative models of care delivery, including care coordination, telemedicine, and population health initiatives.
Foster a culture of continuous improvement by encouraging innovation and the adoption of best practices across clinical teams.
Qualifications
Education:
Master’s degree in Healthcare Administration, Public Health, Nursing, or related field required.
Clinical licensure (RN, NP, MD, DO, etc.) preferred but not required.
Experience:
7+ years of experience in healthcare, with at least 5 years in quality improvement, clinical performance, or value-based care.
Proven leadership experience in managing clinical teams and quality improvement initiatives in a healthcare setting.
Strong understanding of value-based care models, clinical performance metrics, quality improvement methodologies (e.g., Plan-Do-Study-Act (PDSA), Six Sigma), and healthcare regulations.
Experience with healthcare data analytics, performance reporting, and familiarity with CMS quality programs (HEDIS, MACRA, MIPS, etc.).
Skills and Competencies:
Excellent communication, presentation, and interpersonal skills, with the ability to engage stakeholders at all levels of the organization.
Strong problem-solving and analytical skills, with the ability to use data to inform decisions and drive performance improvement.
Proficiency in healthcare management software, EHR systems, and data analytics platforms.
Knowledge of accreditation processes and regulatory requirements in value-based care settings.
Seniority level Seniority level Director
Employment type Employment type Full-time
Job function Job function Quality Assurance
Industries Non-profit Organizations
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