Director of Quality and Value Based Solutions
Apply NowCompany: Columbia Basin Health Association
Location: Othello, WA 99344
Description:
Overview
Primary Responsibilities:
The Director of Quality and Value Based Solutions supports Columbia Basin Health Association in serving its members through development and execution of strategic goals focused on transforming the delivery of care to improve patient experience, quality, outcomes, and reduce the total cost of care. This position will provide operational, financial, and administrative direction and expertise through evaluation and coordination of a comprehensive array of services and programs for health-care delivery system, in conjunction with compliance requirements, to promote a value-based approach to care rooted in a population health strategy. The Director of Quality and Value Based Solutions will serve as a mentor to staff and to health-care partners, an advocate in the community and a relationship-builder with Providers across service lines. This position will promote opportunities of synergy associated with a multi-disciplinary team approach to operating and evolving health center services.
Director of Quality & Value Based Services Salary: $102,342.00-$127,928.00
Responsibilities
Description of Primary Responsibilities:
1. Staff Management and Leadership
a. Partners with Leaders and Provider Teams to focus transformation efforts around quality, care coordination, and population health.
b. Partners with financial and clinical operations to integrate a team based approach to care, focusing on patients at the center of quality, low cost care.
c. Participates in the development of long-range strategic plans, governance structure and objectives for practice management, is a major contributor to the grants compliance process and is responsible for the organization's Coordinated Quality Improvement Plan (CQIP).
d. Participates in the recruitment and retention of professional and non-exempt staff.
e. Develop working relationships with all stakeholders to continually improve care delivery through proactive patient outreach for preventative work, programs for care coordination and chronic disease management, utilization management, and total cost of care.
f. Evaluates staff performance and work quality to ensure consistency and adherence to policies and procedures, and provide coaching, guidance and support, set professional development plans to assist employees to reach their full potential through the performance management process.
g. Builds and develops effective teams, coach and develop others and lead the team to recruit and retain high caliber staff.
h. Communicates effectively and leads others through change and new strategic initiatives.
i. Demonstrates commitment to the organization and displays Leadership attributes internally and externally.
2. Business/Clinical Processes
a. Collaborates in the development of Business Intelligence data related to MCO, ACO, and UDS as it relates to care gaps, quality, and population health management.
b. Develops PowerBI, Azara Dashboards for Care Coordination, Quality Care Gaps, Chronic Care Management, Population Health, Behavioral Health, Referrals, and Health Education.
c. Develops patient engagement strategies for innovation with digital outreach technology
d. Advances clinical and business performance to positively impact the overall patient experience from pre-appointment to patient departure.
e. Partners with local school district leaders to facilitate and organize CBHA's delivery of outreach services to include dental screenings, dental sealants, behavioral health services, and vision and hearing screenings.
3. Value Based Contracting
a. Monitors VBC financial and quality performance.
b. Partners with finance and operations to focus on key performance indicators related to health plan enrollment, engagement, high cost patients, utilization, quality, care coordination, coding, outreach, and risk stratification.
c. Partners with Community Clinic Contracting Network (CCCN) to identify opportunities for revenue capture as identified by CCCN Portal, Enrollment Manager, Plan Rosters, and Plan Attribution.
4. Policy Management
a. Develops, interprets, implements and enforces medical management policies and procedures, to include dental, optometry, laboratory, radiology, behavioral health and pharmacy as it relates to quality and patient safety.
b. Ensures policies and procedures comply with all government and accreditation agencies regulations, including but not limited to HRSA, NCQA-PCMH, BPHC, CMMI, FTCA, JC and NCQA.
c. Ensures 100% adherence to policies and procedures for safety, health and security of patients and staff.
5. Clinical Service Delivery/Quality Assurance
a. Develops strategy related to local, state, and federal quality plan measures.
b. Develops targets and plans for quality performance in relation to Managed Care Organization, Accountable Communities of Health, UDS +, and State Value Based requirements.
c. Represents CBHA in Accountable Communities of Health State Transformation initiatives.
d. Monitors staff to ensure for the optimal patient care in regards to patient assessment and evaluation of care.
e. Maintains standards of excellence for clinical cleanliness and monitors staff performance by conducting routine inspections and evaluations.
f. Leads clinical staff in understanding, optimizing, designing systems and processes to increase efficiency and utilization of electronic documentation.
g. Ensures that milestones are met for design, build, testing, training, budget, and activation of electronic medical records upgrades.
h. Develop staff education at all levels to promote accurate documentation to meet regulatory requirements and revenue capture.
i. Facilitates effective working relationships among departments and disciplines to achieve desired organizational outcomes associated with the implementation and optimization of the electronic medical record system.
6. Patient Experience, Engagement and Outreach
a. Develops patient experience and engagement innovation strategies
b. Oversees quality assurance as it relates to patient experience
c. Proactively monitors patient experience scores collected from 3rd party vendor
d. Directs the outreach efforts focused on population health and care coordination initiatives.
7. Problem Solving, Decision Making, Strategic Thinking and Planning Skills
a. Proactively manages and assesses systems to uncover problems, identify potential solutions and make decisions.
b. Ensures that staffing requirements, scheduling, quality control procedures, equipment needs, and supply management are efficient and cost effective.
c. Possesses strong business acumen.
d. Leads special projects as directed by the CEO to a successful end point.
8. Management Reporting, Budgeting and Financial Modeling
a. Ensures effective utilization of information technology databases and software to capture all pertinent patient and clinical information.
b. Manages information technology proficiently and serve as the key point of control for systems to ensure availability of necessary information technology support.
c. Manages all record keeping functions within their realm of control.
d. Prepares and delivers periodic management reports regarding operational effectiveness and performance, including budget management and control of specific departments under their control.
9. Customer Service and Communication
a. Effectively builds relationships, including rapport, influencing and networking skills.
b. Communicates effectively at all levels.
c. Ensures a consistent service delivery in a consultative and solutions-based capacity to all levels of staff and external contacts with regards to operational related plans, policies and procedures.
Qualifications
Description of Primary Attributes:
General Development:
1. Analytical - Designs efficient workflows and procedures in line with the policies of the organization.
2. Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions.
3. Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.
4. Interpersonal - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
5. Team Work - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests.
6. Change Management - Develops workable implementation plans; communicates changes effectively; builds commitment and overcomes resistance; prepares and supports those affected by change, monitors transition and evaluates results.
7. Managing People - Takes responsibility for subordinates' activities; be available to staff; provides regular performance feedback; continually works to improve supervisory skills.
8. Cost Consciousness - Develops and implements cost saving measures; conserves organization resources.
9. Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate plan.
10. Managerial Courage - The ability to say what needed to be said at the right time, to the right person, and in the right manner; and the ability to make the right decision even when the decision is not the most popular one.
Professional and Technical Knowledge:
1. A thorough understanding of the theory and practices of healthcare, typically acquired through completion of a Master's Degree program with a major or concentration in Business Administration from an accredited college or university. Education can be substituted by minimum of 10 years of Healthcare Management experience and training to include related certifications from certifying bodies such as MGMA, HFMA, and AAPC.
2. Knowledge of applicable federal and state privacy laws, including the Privacy Rule, privacy accreditation and licensure standards relating to health care and CBHA's information and privacy practices.
3. Familiar with advancements in information privacy strategies and technologies to ensure practice adaptation and compliance.
4. Possesses a high level of supervisory skill and expertise, including the management and development of multiple staff members performing jobs of varying responsibility and level, typically not acquired in less than five years of progressively greater levels of responsibility.
5. Possess or the desire and effort to attain the following certifications: MGMA-Certified Medical Practice Executive, NCQA-CPHQ, PCMH-CCE.
Technical Skills:
1. Possesses knowledge of statistics, data collection, outcome measurements and ability to prepare and interpret data in complex documents, including tables, charts, graphs and other elements.
2. Ability to utilize software relative to formation of letters, graphs, and other documents as necessary to perform operational duties.
3. Ability to develop sophisticated presentations in Microsoft PowerPoint, including the use of embedded objects, transitions and other elements.
Communication Skills:
1. Job duties require the employee to effectively communicate complex and/or technical information to co-workers and others.
2. Employees are required to negotiate resolutions to complex situations which may be inherently adversarial.
3. Employees must determine appropriate methods of communicating information through the use of tables, graphs, charts and other visual forms
4. Duties require preparation and execution of presentations to large groups
5. Speaks clearly and persuasively in appositive or negative situation; listens and gets clarification, responds well to questions; participates in meetings.
6. Able to communicate effectively in a professional manner.
Physical Demands & Requirements:
1. Ability to stand, walk, sit, use hands, fingers, reach with arms, stoop, kneel, and talk frequently.
2. Ability to lift up to 10 pounds
3. Close vision (clear vision at 20 inches or less)
4. Distance vision (clear vision at 20 feet or more)
5. Ability to adjust focus (ability to adjust the eye to bring an object into sharp focus)
6. Travel required
7. Requires evening and/or weekend work
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give
Primary Responsibilities:
The Director of Quality and Value Based Solutions supports Columbia Basin Health Association in serving its members through development and execution of strategic goals focused on transforming the delivery of care to improve patient experience, quality, outcomes, and reduce the total cost of care. This position will provide operational, financial, and administrative direction and expertise through evaluation and coordination of a comprehensive array of services and programs for health-care delivery system, in conjunction with compliance requirements, to promote a value-based approach to care rooted in a population health strategy. The Director of Quality and Value Based Solutions will serve as a mentor to staff and to health-care partners, an advocate in the community and a relationship-builder with Providers across service lines. This position will promote opportunities of synergy associated with a multi-disciplinary team approach to operating and evolving health center services.
Director of Quality & Value Based Services Salary: $102,342.00-$127,928.00
Responsibilities
Description of Primary Responsibilities:
1. Staff Management and Leadership
a. Partners with Leaders and Provider Teams to focus transformation efforts around quality, care coordination, and population health.
b. Partners with financial and clinical operations to integrate a team based approach to care, focusing on patients at the center of quality, low cost care.
c. Participates in the development of long-range strategic plans, governance structure and objectives for practice management, is a major contributor to the grants compliance process and is responsible for the organization's Coordinated Quality Improvement Plan (CQIP).
d. Participates in the recruitment and retention of professional and non-exempt staff.
e. Develop working relationships with all stakeholders to continually improve care delivery through proactive patient outreach for preventative work, programs for care coordination and chronic disease management, utilization management, and total cost of care.
f. Evaluates staff performance and work quality to ensure consistency and adherence to policies and procedures, and provide coaching, guidance and support, set professional development plans to assist employees to reach their full potential through the performance management process.
g. Builds and develops effective teams, coach and develop others and lead the team to recruit and retain high caliber staff.
h. Communicates effectively and leads others through change and new strategic initiatives.
i. Demonstrates commitment to the organization and displays Leadership attributes internally and externally.
2. Business/Clinical Processes
a. Collaborates in the development of Business Intelligence data related to MCO, ACO, and UDS as it relates to care gaps, quality, and population health management.
b. Develops PowerBI, Azara Dashboards for Care Coordination, Quality Care Gaps, Chronic Care Management, Population Health, Behavioral Health, Referrals, and Health Education.
c. Develops patient engagement strategies for innovation with digital outreach technology
d. Advances clinical and business performance to positively impact the overall patient experience from pre-appointment to patient departure.
e. Partners with local school district leaders to facilitate and organize CBHA's delivery of outreach services to include dental screenings, dental sealants, behavioral health services, and vision and hearing screenings.
3. Value Based Contracting
a. Monitors VBC financial and quality performance.
b. Partners with finance and operations to focus on key performance indicators related to health plan enrollment, engagement, high cost patients, utilization, quality, care coordination, coding, outreach, and risk stratification.
c. Partners with Community Clinic Contracting Network (CCCN) to identify opportunities for revenue capture as identified by CCCN Portal, Enrollment Manager, Plan Rosters, and Plan Attribution.
4. Policy Management
a. Develops, interprets, implements and enforces medical management policies and procedures, to include dental, optometry, laboratory, radiology, behavioral health and pharmacy as it relates to quality and patient safety.
b. Ensures policies and procedures comply with all government and accreditation agencies regulations, including but not limited to HRSA, NCQA-PCMH, BPHC, CMMI, FTCA, JC and NCQA.
c. Ensures 100% adherence to policies and procedures for safety, health and security of patients and staff.
5. Clinical Service Delivery/Quality Assurance
a. Develops strategy related to local, state, and federal quality plan measures.
b. Develops targets and plans for quality performance in relation to Managed Care Organization, Accountable Communities of Health, UDS +, and State Value Based requirements.
c. Represents CBHA in Accountable Communities of Health State Transformation initiatives.
d. Monitors staff to ensure for the optimal patient care in regards to patient assessment and evaluation of care.
e. Maintains standards of excellence for clinical cleanliness and monitors staff performance by conducting routine inspections and evaluations.
f. Leads clinical staff in understanding, optimizing, designing systems and processes to increase efficiency and utilization of electronic documentation.
g. Ensures that milestones are met for design, build, testing, training, budget, and activation of electronic medical records upgrades.
h. Develop staff education at all levels to promote accurate documentation to meet regulatory requirements and revenue capture.
i. Facilitates effective working relationships among departments and disciplines to achieve desired organizational outcomes associated with the implementation and optimization of the electronic medical record system.
6. Patient Experience, Engagement and Outreach
a. Develops patient experience and engagement innovation strategies
b. Oversees quality assurance as it relates to patient experience
c. Proactively monitors patient experience scores collected from 3rd party vendor
d. Directs the outreach efforts focused on population health and care coordination initiatives.
7. Problem Solving, Decision Making, Strategic Thinking and Planning Skills
a. Proactively manages and assesses systems to uncover problems, identify potential solutions and make decisions.
b. Ensures that staffing requirements, scheduling, quality control procedures, equipment needs, and supply management are efficient and cost effective.
c. Possesses strong business acumen.
d. Leads special projects as directed by the CEO to a successful end point.
8. Management Reporting, Budgeting and Financial Modeling
a. Ensures effective utilization of information technology databases and software to capture all pertinent patient and clinical information.
b. Manages information technology proficiently and serve as the key point of control for systems to ensure availability of necessary information technology support.
c. Manages all record keeping functions within their realm of control.
d. Prepares and delivers periodic management reports regarding operational effectiveness and performance, including budget management and control of specific departments under their control.
9. Customer Service and Communication
a. Effectively builds relationships, including rapport, influencing and networking skills.
b. Communicates effectively at all levels.
c. Ensures a consistent service delivery in a consultative and solutions-based capacity to all levels of staff and external contacts with regards to operational related plans, policies and procedures.
Qualifications
Description of Primary Attributes:
General Development:
1. Analytical - Designs efficient workflows and procedures in line with the policies of the organization.
2. Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions.
3. Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.
4. Interpersonal - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
5. Team Work - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests.
6. Change Management - Develops workable implementation plans; communicates changes effectively; builds commitment and overcomes resistance; prepares and supports those affected by change, monitors transition and evaluates results.
7. Managing People - Takes responsibility for subordinates' activities; be available to staff; provides regular performance feedback; continually works to improve supervisory skills.
8. Cost Consciousness - Develops and implements cost saving measures; conserves organization resources.
9. Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate plan.
10. Managerial Courage - The ability to say what needed to be said at the right time, to the right person, and in the right manner; and the ability to make the right decision even when the decision is not the most popular one.
Professional and Technical Knowledge:
1. A thorough understanding of the theory and practices of healthcare, typically acquired through completion of a Master's Degree program with a major or concentration in Business Administration from an accredited college or university. Education can be substituted by minimum of 10 years of Healthcare Management experience and training to include related certifications from certifying bodies such as MGMA, HFMA, and AAPC.
2. Knowledge of applicable federal and state privacy laws, including the Privacy Rule, privacy accreditation and licensure standards relating to health care and CBHA's information and privacy practices.
3. Familiar with advancements in information privacy strategies and technologies to ensure practice adaptation and compliance.
4. Possesses a high level of supervisory skill and expertise, including the management and development of multiple staff members performing jobs of varying responsibility and level, typically not acquired in less than five years of progressively greater levels of responsibility.
5. Possess or the desire and effort to attain the following certifications: MGMA-Certified Medical Practice Executive, NCQA-CPHQ, PCMH-CCE.
Technical Skills:
1. Possesses knowledge of statistics, data collection, outcome measurements and ability to prepare and interpret data in complex documents, including tables, charts, graphs and other elements.
2. Ability to utilize software relative to formation of letters, graphs, and other documents as necessary to perform operational duties.
3. Ability to develop sophisticated presentations in Microsoft PowerPoint, including the use of embedded objects, transitions and other elements.
Communication Skills:
1. Job duties require the employee to effectively communicate complex and/or technical information to co-workers and others.
2. Employees are required to negotiate resolutions to complex situations which may be inherently adversarial.
3. Employees must determine appropriate methods of communicating information through the use of tables, graphs, charts and other visual forms
4. Duties require preparation and execution of presentations to large groups
5. Speaks clearly and persuasively in appositive or negative situation; listens and gets clarification, responds well to questions; participates in meetings.
6. Able to communicate effectively in a professional manner.
Physical Demands & Requirements:
1. Ability to stand, walk, sit, use hands, fingers, reach with arms, stoop, kneel, and talk frequently.
2. Ability to lift up to 10 pounds
3. Close vision (clear vision at 20 inches or less)
4. Distance vision (clear vision at 20 feet or more)
5. Ability to adjust focus (ability to adjust the eye to bring an object into sharp focus)
6. Travel required
7. Requires evening and/or weekend work
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give