Manager, Clinical Quality & Safety (RN)

Manager, Clinical Quality & Safety (RN)

Salary Range: $122,529 - $189,920
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status:Exempt
Department:Quality Improvement
Reports To:Director, Quality & Process Improvement

GENERAL DESCRIPTION OF POSITION

The Manager of Clinical Quality & Safety oversees the day-to-day clinical operations of the quality activities at the health plan including the Quality Improvement (QI) program. This includes oversight of the Potential Quality of Care Issue (PQI) investigation process, Facility Site Review (FSR), Initial Health Assessment (IHA) audits and HEDIS Medical Record Review (MRR) process. The Manager of Clinical Quality & Safety works cross-functionally to support all projects to improve quality of care and quality of service at the plan and is responsible for leading and managing the staff who perform those activities.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Work with internal business units and external providers and community partners to drive quality improvement projects at the health plan to improve quality of care and quality of service.
2. Develop and track metrics related to quality improvement activities including collecting, analyzing and reporting by appropriate statistical reports.
3. Manage the QI program including Initial Health Assessment (IHA) audit and tracking, PQI, FSR, HEDIS MRR, quality related internal and external audits and other required regulatory submissions.
4. Manage other projects as needed that support quality outcomes and organizational goals.
5. Manage vendors and contractors used for QI and HEDIS to ensure they perform according to contract compliance and effectively meet plan needs.
6. Identify issues, trends, and opportunities to improve quality, or to better assist departments; develop recommendations and implement the same relative to identified issues, trends, and opportunities.
7. Maintain a thorough knowledge of applicable laws and regulations in order to effectively monitor and ensure compliance with CMS, DHCS, DMHC and other applicable agency and program requirements.
8. Develop policies and procedures to ensure adherence to contractual, legal and regulatory requirements.
9. Attend off site meetings or events as necessary.
10. Perform other related duties as required or assigned.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include:

1. Recruiting, interviewing, and hiring.
2. Developing a high performing department, culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance.
4. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work.
5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor's Degree in Health Administration, Public Health, Nursing, or related field; or equivalent experience, training, or coursework. (R)
2. Active California RN License without restriction. (R)
3. Minimum two years of experience with the duties and responsibilities described above. (R)
4. Minimum two years of work experience with a managed care plan, Medi-Cal or Medicare programs, hospital, health system or clinic. (R)
5. Demonstrated project management and data analysis skills. (R)
6. Strong understanding of quality improvement methodologies. (R)
7. Ability to think creatively and work strategically, to help drive innovative solutions yielding measurable results to the organization. (R)
8. Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff. (R)
9. Strong working knowledge and proficient with Microsoft Office applications, and the ability to operate all applicable software. (R)
10. Excellent oral and written communication skills, including the ability to express oneself clearly and concisely.(R)
11. Ability to effectively facilitate meetings and deliver information/presentations to management, regulators and staff. (R)
12. Self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast paced, dynamic environment with a high level of ambiguity. (R)
13. Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision. (R)
14. Ability to think creatively and work strategically, to help drive innovative solutions yielding measureable results to the organization. (R)
15. Ability to gather and analyze data, organize and write reports, and organize work efficiently. (R)
16. Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
17. Ability to maintain confidentiality. (R)
18. Ability to comply with all SCFHP policies and procedures. (R)
19. Ability to perform the job safely with respect to others, to property, and to individual safety. (R)
20. Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors in person, by telephone and via work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

EOE