Executive Director Quality Programs & Services

Overview

As the Executive Director of Quality Programs and Services, you will be responsible for leading and overseeing all aspects of quality assurance, program development, and service delivery within our organization. This role requires a strategic thinker with a strong background in quality management, program development, and leadership.

Talent Pool: Leadership

Responsibilities

Strategic Leadership: Develop and execute a comprehensive strategy for advancing quality initiatives within the value-based care framework. Collaborate with executive leadership to align quality goals with risk-based payer contracts, organizational objectives, industry best practices & `best in class? innovations.

Performance Measurement & Reporting: Oversee the development and maintenance of performance measurement systems to track key quality indicators and metrics. Generate regular reports to communicate performance outcomes, trends, and areas for improvement to relevant stakeholders, including executive leadership, clinical teams, and external partners.

Quality Assurance: Establish and maintain rigorous quality assurance processes to ensure that all programs and services meet or exceed internal and external policies & standards. Develop and implement process and performance metrics and evaluation processes to assess the effectiveness and impact of all quality programs and services.

Program Development: Lead the development of new programs and services in response to identified needs and other requirements. Includes establishing and partnering in consistent and reliable approaches to care gap closure, HCC coding quality, and RAF score optimization. Lead efforts to continuously improve the quality, efficiency, and effectiveness of programs and services through innovation, process optimization, and best practices.

Quality & Safety Improvement Initiatives: Identify potential risks and vulnerabilities related to quality of care and patient safety within the value-based care model. Develop and implement risk mitigation strategies to minimize adverse events and optimize patient outcomes. Lead the design, implementation, and evaluation of quality improvement initiatives aimed at enhancing clinical outcomes, patient satisfaction, and operational efficiency, in coordination with other areas (e.g., Population Health, Care Coordination, Clinical Documentation Improvement, Ambulatory Clinics, etc.)

Departmental Management: Provide leadership and direction to a team of quality specialists, program managers, and other staff members, fostering a culture of excellence, collaboration, and continuous improvement. Oversee the budgeting process for quality programs and services, ensuring efficient allocation of resources and adherence to financial targets.

Collaboration & Stakeholder Engagement: Foster collaboration and partnerships with internal and external stakeholders, including healthcare providers, payers, community organizations, and regulatory agencies. Work closely with cross-functional teams to implement quality improvement initiatives meeting stakeholder needs and expectations. Promote a culture of continuous learning and improvement.

Technology and Data Analytics: Leverage current and emerging technologies for efficiency and high reliability of processes and results. Analyze data in partnership with relevant departments and resources, ensuring accurate and actionable insights to guide the Quality program. Actively engage stakeholders, promoting optimal use of data and technology to drive better outcomes.

Regulatory Compliance: Stay abreast of relevant laws, regulatory requirements and accreditation standards related to value-based care quality initiatives. Ensure organizational compliance with applicable regulations and standards, and lead efforts to prepare for and respond to audits and assessments.

Education & Training: Develop and deliver educational programs and training sessions to promote awareness and understanding of value-based care principles, quality improvement methodologies, technological solutions, optimized HCC Coding strategies, and other related best practices among clinical and non-clinical staff. Qualifications:

EDUCATION:Required: Bachelors with Clinical degree in Nursing or Pharmacy

Preferred: MBA or MHA

EXPERIENCE:Required:

Minimum of 10 years of progressive leadership experience in population health management, care coordination, or healthcare program development within an integrated delivery system.

Demonstrated expertise in developing and implementing population health strategies, including risk stratification, care management, and health promotion initiatives.

Strong understanding of healthcare delivery systems, value-based care models, and payment reform initiatives.

Proven track record of successfully developing and implementing programs and services that meet or exceed risk-based contracting quality standards and deliver measurable results.

Minimum of 3 years of experience in a Value-based care, CIN, or ACO.

Preferred

Experience working in a regulated industry or with regulatory agencies

Leadership experience preferably in a value based, ACO, or clinically integrated environment.

LICENSURE/CERTIFICATION/REGISTRY/LISTING:Required: Valid Driver's License | If driving Cone Health vehicle, must have 5 years of driving experience and MVR must be approved by Risk Management.

Preferred: Registered nurse or physician.

Certified Professional in Healthcare Quality (CPHQ)