Area Quality Leader

$200,700 - $250,000 yearly
  • The Resume Review - Recruiting Department
  • Santa Clara, CA, USA
  • Feb 05, 2024
Full time Health Care

Job Description

Job description
Job Summary:
Drives clinical quality and safety programs. Responsible for the strategic development, planning and control of health plan and hospitals quality programs and for leading the implementation of compliant programs at the facility, including associated alliance hospitals and other non-KFH facilities. Facilitates the development of programs and processes that meet regulatory requirements. Focuses on organization-wide systems and processes for improvement, including clinical quality management, risk management, AR&L and patient safety activities in collaboration with clinical and administrative personnel. Serves as Patient Safety Officer for assigned hospitals. Oversees and facilitates internalization and monitoring of Regional Sub-regional Services.  Ensures practitioner review and oversight meets internal standards. Responsible for quality program oversight, associated medical staff issues, member concerns and grievances to ensure submission to accreditation and regulatory bodies are timely and accurate; and ensures that processes supporting submissions are reliable. Facilitates health plan assessment of quality programs at the medical center including MDQR. Develops strong collaborative leadership relationships with TPMG, external regulatory agencies, accreditation bodies, employer groups.  Has joint accountability to develop systems and corrective action plans for the facility to meet regulatory compliance.
Essential Responsibilities:
    • Accountable for the development and implementation of programs across the facility, which encompass strategic planning for the achievement of quality outcomes.
    • Establishes appropriate Hospital/Health Plan oversight through partnership with TPMG, the medical center executive leadership team and departments. Leads quality and patient safety efforts related to the implementation of electronic medical records.  In conjunction with the Assistant Administrator for Patient Care Services and TPMG leadership, develops and drives performance improvement activities that are cost-effective and efficient.
    • Responsible for leading the design of reliable systems that support evidence based optimal care in both hospital and non-hospital setting. With TPMG, implements and monitors disease management programs and processes across the continuum of care.
    • Monitors and assesses clinical quality and service trends, external environment and internal practices, and makes recommendations to develop/adjust strategy to meet the changing business and market conditions.
    • Supports and oversees the use of evidence based guidelines, criteria and other clinical tools to reduce variation in clinical practice and to optimize clinical outcomes. Evaluates performance through the development/maintenance of statistical processes, control charts and regulatory databases.
    • Directs accreditation, licensing and regulatory activities and ensures compliance in all applicable settings, including but not limited to MDQR, NCQA, The Joint Commission, DMHC, DHS, Medi-Cal, Cal-OSHA, and CMS. Implements sustainable systems for meeting accreditation, regulatory and licensing requirements. Assigns direct accountability for oversight within the quality department and ensures operational integrity for performance.
    • Ensures that facility policies, practices, and procedures comply with administrative, legal and regulatory requirements of health plan, health plan contracts and governmental and accrediting agencies.  Identifies new legislations affect on Hospital/Health Plan and leads programs that ensure alignment with new legislation.
    • Accountable for comprehensive infection control programs for surveillance prevention, data analysis and reporting, and control of infections across hospital, medical group, and environmental support departments and serves as liaison for infectious disease and the department of public health.  
    • Ensures that the environment of care is safe, functional, supportive and effective both for the delivery of patient care and protection of the worker. In collaboration with other KFH/P leaders, is accountable for achieving the KFH/P Board requirements.
    • Collaborates with medical staff to support the medical staff functions including peer review and the practitioner performance review and oversight process. Ensures appropriate level of Health Plan oversight with respect to peer review .  Ensures development of a safe culture through responsible reporting of unusual events, human factors training, and design of systems for safe and reliable practices.  
    • Partners with TPMG as appropriate to implement these systems and integrate into operations.
    • Ensures KFHP provides appropriate oversight for hospital risk issues.  Collaborates with the ombudsman to ensure rapid resolution of patient concerns and grievances and establishes system changes to address the underlying complaint.  As an agent of the Health Plan, works with member service directors to ensure the member grievance and complaint process has the appropriate level of qualitative and quantitative review to comply with all legal and regulatory requirements for Hospital/Health Plan.
    • Provides consultation to senior facility leaders to advance culture change.
    • Provides defined mechanisms to encourage staff at all levels to Speak Up on patient safety and quality concerns.
    • Ensures alignment with HR policies and procedures.
    • Provides leadership in building a team and organization which will assume responsibility and accountability for achieving the mission and objectives of KP.
    • Creates a culture which is decisive, action-oriented, flexible, and poised to seize opportunities to advance quality, safety and performance.

  • Provides leadership in developing and executing key strategies which differentiate KP from its competitors in the area of quality, patient safety and clinical excellence.
  • Provides leadership as the hospitals Patient Safety Officer. Develops and maintains oversight for patient safety and risk management programs.
  • Facilitates the ongoing improvement of systems to reduce medical errors.
  • Ensures that the quality and safety programs are consistent with cultural diversity; assesses for consistency with healthcare literacy issues and language access requirements.  
  • Directs, implements and evaluates a comprehensive risk management plan for the facility to reduce or eliminate the potential for financial loss.
  • Ensures the integration of quality, and patient safety improvements into day-to-day operations.  
  • Collaborates with facility management team and area manager to develop the overall financial plan. Assures short and long-range financial goals are met by establishing and controlling budgets.  Engages in processes to identify financial risk of medical errors, implements programs that reduce the risk of medical errors, and to drive Performance Improvement.
  • We conduct compensation reviews of positions on a routine basis.  At any time, we reserve the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status.  Such changes are generally implemented only after notice is given to affected employees.
Basic Qualifications:
  • Minimum ten (10) years of experience in clinical and management roles in a health plan or multi-faceted health care system and multi-provider settings.  
  • Masters degree in business, health care, public administration or related field.
License, Certification, Registration
  • N/A
Additional Requirements:
  • Thorough knowledge of quality assurance, quality improvement, utilization review, risk management, and accreditation and licensing requirements including The Joint Commission, NCQA, Knox-Keene Act, Federal HMO Act, CMS, Cal-OSHA, Public Employees Medical and Hospital Act, HIPAA and Medi-Cal regulations and standards.
  • Track record achieving superior results that demonstrate performance improvement and quality and service outcomes.
  • Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
  • Clinical license such as RN or Pharm. D preferred.