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Job Summary
Provide strategic oversight and guidance to small- and/or medium-sized service areas (facilities with fewer than 300 licensed beds) by leading the development and implementation of clinical quality programs and initiatives. Serve as a leader and expert on clinical quality management, proactively monitor performance metrics, champion evidence-based guidelines, direct accreditation, licensing, and regulatory compliance, and partner with medical staff to support peer review, practitioner performance review, and risk reduction.
Essential Responsibilities
- Leadership & Talent Development: Build organizational capacity and prepare high potentials for growth and advancement. Provide frameworks for goal-setting, performance feedback, and coaching. Drive continuous learning, oversee talent recruitment and development, and maintain an engaged workforce by aligning cross-functional resources with business objectives. Act as a thought leader on industry trends, benchmarks, and best practices.
- Operational Strategy: Oversee multi-unit or department operations, translate business strategy into actionable requirements, and ensure products/services meet organizational goals. Engage cross-functional business units to champion priorities, allocate resources, and resolve escalated issues. Serve as a trusted subject-matter expert and consultant to executive leadership.
- Quality Improvement & Regulatory Compliance: Serve as the subject matter expert on clinical quality improvement processes and regulations for internal and external stakeholders. Provide consultation on policy implementation and long-term strategy adaptation. Foster collaborative partnerships to ensure current and future compliance, identify and remove process barriers, and direct regulatory audits and continuous survey readiness activities.
- Grievances & Quality of Care: Represent the organization in grievance meetings, cases, reviews, and referrals. Direct the preparation of sensitive patient case reviews, report trends in investigations, appeals, and claims, and define standards for the surveillance of quality improvement metrics and near misses.
- Infection Prevention & Patient Safety: Oversee infection prevention and control programs, leading epidemiological investigations and serving as the primary contact during significant outbreak containment protocols. Direct risk management efforts utilizing root cause analysis, failure mode effects analysis, and corrective action plans. Accountable for patient safety programs, managing significant event responses and safety hazards.
- Data Management & Care Effectiveness: Oversee systems, procedures, and data management programs to monitor and improve worker and patient safety. Translate data from databases, vital statistics, hospital discharges, and claims into long-term strategic advice. Define standards for evaluating the cost-effectiveness, practicality, and appropriateness of medical care, driving population health needs and policy updates.
Qualifications
- Education: Master’s degree in Business, Health Care, Public Administration, or a directly related field.
- Experience:
- Minimum 10 years of experience in clinical and management roles in a health plan or multi-faceted health care system across multi-provider settings.
- Minimum 7 years of health care or directly related experience (if holding a Master’s degree).
- Minimum 9 years of leadership experience (with or without direct reports).
- Minimum 8 years of experience in a clinical setting, health care administration, or a directly related field.
- Minimum 4 years of experience managing operational or project budgets.
- Minimum 4 years of experience delivering training programs.
- Minimum 6 years of experience working with databases and spreadsheets.
- Certifications: Professional Healthcare Quality Certificate required within 24 months of hire.
- Additional Details: Regular status, standard job type, Director/Senior Director level, with approximately 20% travel required.