Work directly with the Medical Groups and Foundations and is responsible for integration and delivery of Quality Management MSO functions for the Medical Groups and Foundations, in compliance with delegated and regulatory requirements. Lead the integration of MSO Quality Management programs, developing and implementing standard workflows across multiple delivery models, local markets, and diverse populations across the Southern CA market. Responsible for performance in the areas of QM related issues, data management/submission, Appeals & Grievances, ICE Reporting, CAPs, Pay for Performance/CMS 5 Star, Patient Satisfaction Survey process and reporting, CAPG Standards of Excellence Survey preparation and submission. Create a scalable organizational structure to support the medical groups through growth, including acquisitions of patient populations and provider groups. Supervise the daily activities of the Quality Management Department Staff and the Appeals & Grievance Coordinators to assure accurate and timely response to health plans.
Direct the oversight of reporting, compliance, efficiency and accuracy of the QM process as delegated by each PSA with the health plans, including quality metrics management and reporting, event reporting, appeals and grievances, and patient safety in the ambulatory setting, in accordance with our Program Plan, policies and procedures. Assist in developing and implementing a robust set of actionable quality reports and tools such as the MDX Registry and documentation of workflows to improve quality metrics and patient outcome. Instrumental in developing and implementing tools to improve accountability and patient safety, such as High Reliability Organization (HRO). Responsible for compliance with health plans/NCQA/DMHC health care quality mandates and for the preparation and submission of audits and required health plan reports. Collaborate with Providence Health and Services (PHSCA) Medical Groups and Foundations leadership on all audits results and needed corrective action plans.
Effectively drive consistent high quality care delivery in a rapid growth environment and across multiple ambulatory care delivery systems (employed, contracted and IPA) and various risk levels. Lead integration across the MSO in delivering QM functions cross multiple medical groups. Drive rapid process improvement to increase organizational efficiency. Effectively use data to evaluate opportunities, support interventions and measure results. Instrumental in the evaluation, selection process and implementation of technology solutions to support QM functions. Lead organizational and cultural transformation, and inspires others to create highly effective teams. Demonstrate effectiveness and ability to work in partnership across reporting and organizational structures, including hospitals, partners and medical groups in Southern CA.
Bachelor’s in Nursing.
Minimum three to five years experience of clinical nursing in an acute care setting with strong emphasis on medical/surgical nursing or specialty area.
Minimum two years of ambulatory care experience.
Experience in developing educational programs and procedures required.
Knowledge of Title XXII, NCQA, AAAHC requirements and standards, CDC and infection control standards, building codes, fire department safety standards, OSHA requirements (Title VIII).
Must possess excellent teaching skills including presentation.
Experience with HMOs and health plans highly recommended.
Preferred qualifications for this position include:
Facey Medical Group, an affiliate with Providence Health & Services, has offices that dot the San Fernando, Santa Clarita and Simi Valleys. We've been a part of Southern California communities for over 90 years! We pride ourselves on our delivery of comprehensive care services and remain committed to the wellness of the community. Facey offers a complete education program that includes classes ...on osteoporosis, weight management, diabetes and more.
Facey Medical Group has expanded to be wherever you are and we're here for you in many ways. Facey physicians are board-certified, so you can feel better right from the start. Plus, our primary care physicians, specialists, and many services such as X-ray and EKG all are under one roof.
Facey physicians are flexible, participating in most insurance plans. We want you to be completely satisfied with your physician and the facility you go to for service. If your employer selects different insurance coverage or you wish to choose a new location or physician, call us and we'll help you through the process. Whether you are in a fee-for-service health plan, Medicare, a Preferred Provider Plan, or an HMO, our family is here for your family.