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Director, Clinical Quality Programs
Ref No.: 17-01860
Location: El Segundo, California
Position Type:Direct Placement
Start Date: 06/02/2017
Job description
 Overview:
Responsible for the management and optimization of the overall Quality Improvement Program for  DaVita HealthCare Partners (DHCP) and reports directly to the Senior Quality Direct and the Quality Medical Director. 
Manages the Quality Department Managers and the  support staff directly.
   Responsible for the day-to-day operations of the Quality Improvement and Credentialing Program.  Participates in or provides direction in the development and implementation of quality improvement projects improving clinical and/or service outcomes.  Interfaces with health plans, Managed Care department or other entities to ensure regulatory requirements pertaining to quality improvement activities are met.  Works as a cross-functional team member with physicians, peers, and others throughout the organization to ensure the delivery of quality care and services.
 
Essential Functions:
 
Creates and supports an environment where improvement ideas, team-building and creative thinking are encouraged to meet the organization's needs for process improvement.
Reviews and evaluates NCQA, DMHC, CMS, Medicaid, and any other regulatory quality improvement requirements to ensure DHCP meets these standards.
Reviews, revises and amends the Quality Improvement Program and Work Plan at least annually as applicable.
Works with the Senior Director of Quality  in the creation of reports and analysis of data that will meet the needs of the regions and the Office of the Medical Director (OMD).
Provides supervision and guidance to the Central and Regional Quality Teams with grievance investigations and resolutions, QI and Peer Review Committees, QI studies, credentialing, central QI database and other related activities.
Participates in and supports organizational committees such as the OMD, Medical Committee, Regional Quality and Peer Review.
Accountable for organizing and facilitating the quarterly Quality  and Language Assistance meetings including maintaining a management process for the gathering of reports and the integration into a cohesive presentation.
Works in collaboration with the OMD, Care Management, Risk Management, Regional QI and Peer Review Committees and other departments to identify opportunities for quality improvement and implementation of improvement activities.
Submits a semiannual quality improvement report to health plans and any other requests as applicable.
Ability to interact with cross functional departments including operations, IT, and the medical management team.
Reviews Language Assistance DMHC regulations and updates the Language Assistance Program as needed.
Ensures that health plan corrective action plans are submitted timely.
Identifies, develops and oversees the educational needs of the QI staff, providers and others in the area of quality improvement.
Key participant in health plan and DMHC quality oversight audits.
Motivates and leads the QI department in setting and reaching departmental goals.
Develops and manages an annual departmental budget and goals.
Uses, protects, and discloses HCP patients' protected health information
(PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
Qualifications:
 
EDUCATION:
Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
Current California RN license.
Degree in Nursing preferred.
Master's degree in Nursing, Health Administration, Public Health or related area preferred.
EXPERIENCE:
 
Minimum:
Over 5 years of experience in the healthcare industry.  Experience in Quality and HEDIS preferred.
Preferred:
3 years of quality management experience in a medical group/IPA or HMO setting.
KNOWLEDGE, SKILLS, ABILITIES:
Computer literate.
Ability to make judgments regarding medical care.
Excellent verbal and written English communication skills.
Good interpersonal skills.
Results-oriented.
 
DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. As of December 31, 2016, DaVita Medical Group's 2,000 employed clinicians, 12,000 teammates, and network of 13,000 affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Group's leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.
 
DaVita Medical Group is an equal opportunity/affirmative action employer.  As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
 
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
 DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.