Director, Ambulatory Quality

Position Summary

The Director of Ambulatory Quality assumes leadership responsibility for the assessment, development, and implementation of clinically effective systems within the ambulatory continuum of care. Leads the organizational strategy and implementation for ambulatory quality initiatives, compliance/regulatory readiness and quality reporting including the HEDIS, Medicare Advantage, MIPS, and other value-based quality program metrics. Develops systems, processes, and metrics for ensuring adherence to the organization's quality expectations and collaborates with providers, operational directors, and clinic managers to develop and drive strategies that create and sustain a culture of clinical excellence. Responsible for the ambulatory facilities quality and patient safety programs with an emphasis on patient safety and harm reduction. Collaborates with Risk Management Department. Ensures adherence to established clinical policies, protocols, regulations, and standards. Applies knowledge of nursing and clinical data management to assist in the design, development, and ongoing modification of computerized health care systems.

Responsibilities

• Collaborative lead and support the FHPG chronic/collaborative care managers, training and compliance nurses, and quality reporting, and improvement specialists to achieve FHPG/FHC goals on time, and on budget while promoting quality and safety.
• Lead quality measurement and reporting programs focused on improving quality and value of the services offered to patients.
• Optimize MIPS, Medicare Advantage, ACO, and other quality metric utilization through researching CMS requirements, rewards, and consequences.
• Lead organizational communication of the information and strategies for success to operational directors, managers, employees, and providers.
• Provide leadership and guidance to operational directors, managers, and assist clinics/departments with attestation/reporting for all providers in every quality program that FHPG/FHC participates in the ambulatory setting.
• Respond to any quality reporting audits with the IT, the data team, operational team, providers, or payer partners as necessary.
• Support EMR based workflow analysis to maintain standards and process integrity while optimizing efficiency and effectiveness.
• Establish clinical reporting requirements and pay for performance plans with an emphasis on streamlined, standard reporting to minimize special requests.
• Collaborates with FHPG stakeholders, IT, Strategy & Innovation, and others to meet CMS attestation/reporting for all quality reporting programs in the Ambulatory setting.
• Monitors the quality of work performed and intervenes, when appropriate, to correct or enhance services.
• Makes timely decisions considering the impact on patient care, financial resources, employee relations, and public image.
• Institute clinical quality monitoring and measurement systems by benchmarking FHPG/FHC and work processes to similar organizations to identify best practices for the purpose of continuous quality improvement.
• Assists in the establishment of operational performance measurements and the monitoring of trends in key performance indicators for the ambulatory sites to evaluate effectiveness, reliability, efficiency, etc. using available information systems data.
• Develop and execute improvement plans to prevent sentinel events, never events, and incidents that impact clinical quality including patient complaints concerning clinical standards or outcomes in the ambulatory setting.
• Support operational process improvement through management reporting and analysis of charting deficiencies and other reports on a monthly, quarterly, or annual basis.
• Must understand how to proficiently use Excel spreadsheets, use formulas, and create pivot tables.
• Works with the VP of Quality & system quality team to ensure ambulatory settings understand and meet with the greatest efficiencies regulatory standards when transitioning patients to hospitals.
• Ensure compliance with patient care, infection control, OSHA, DHHS, CMS, DNV, and other regulatory standards, policies, and procedures.
• Focuses on better healthcare value and quality, including the improvement of clinical outcomes, patient experience, patient safety, cost, revenue, productivity, efficiency, employee and physician satisfaction, and process reliability.
• Develop curriculum and training to promote clinical excellence among clinical staff.
• Other projects as assigned.

Qualifications

Education/formal training/licensure/certification experience:

• Current North Carolina RN license or RN multi-state licensure privilege through the Nurse Licensure Compact required.
• Bachelor’s degree in nursing required. RN required. Masters required. Masters may be in.
• Minimum three (3) years clinical experience required, two (2) years management experience, two (2) years experience in Performance Improvement preferred. Regulatory experience preferred.
• Extensive experience with EMR utilization and implementation (EPIC preferred not required).
• Extensive experience in ambulatory (physician clinic) operations.
• Experience in ensuring compliance with regulations and standards to maintain survey readiness for DNV & other regulatory agencies.
• Experience with Healthcare Quality measurement, reporting and data analysis including provider pay for performance plans.
• Extensive experience with value-based/ACO quality programs/contracts. Examples include but are not limited to: MIPS, Meaningful Use, PQRS, and Medicare Advantage/Hedis.
• Certification in Healthcare Quality preferred (CPHQ); required end of two years.
• Detail oriented.
• Training & presentation experience.
• Experience in deploying clinical quality improvement programs.
• Highly skilled in Excel, Data Extraction, PowerPoint.

Additional skills:

• Ability to interact and communicate with all disciplines in healthcare.
• Ability to interact and communicate with the public, board, and physicians.
• Strong organizational skills.
• Excellent group facilitator techniques and interactive personal skills.
• Intermediate level computer skills.
• Knowledge and skills in statistical and non-statistical tools.
• Excellent written and verbal communication.