Sr Director, Clinical Quality Governance & Regulatory

About the role

The Senior Director, Clinical Quality Governance & Regulatory will provide strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance. This senior leader will serve as a key partner to local and national boards, ensuring effective governance, quality performance, and accountability across health plan and care delivery operations. This position is also responsible for overseeing clinical quality and patient safety management programs including budgets, annual evaluations and revisions, preparation of internal/external reports, consultation services, education initiatives, measurement of outcomes, and improvement strategies related to clinical, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; establishing standards and strategies for the evaluation, design, development, and implementation of evidence-based guidelines, principles, and/or programs related to area of work as well as to reduce variation in clinical practice, optimize patient outcomes, and ensure organizational compliance; leading the collection, analysis, reporting, and presentation of clinical data to identify trends, outliers, and areas for improvement to inform high-visibility, long-term strategy and project goals; developing strategies for education initiatives regarding quality improvement activities, changes to existing processes to meet regulatory requirements, and translating external demands into program goals; serving as a strategic expert on the monitoring, reporting, and development of mitigation plans for all occurrences which may lead to medical center liability; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and developing strategic relationships with applicable government agencies, regulatory agencies, and other organizations.

Essential Responsibilities

• Builds organizational capacity and prepares high potentials for growth opportunities and advancement.
• Oversees the operation of multiple units and/or departments by identifying member and operational needs; ensures the management of work assignment allocation and completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies.
• Directs data collection and analyses to support quality improvement reporting by: overseeing statistical analysis for quality improvement evaluations, special projects, and other work for multidisciplinary review; establishing the long-term plans for the integration and use of multiple utilization data reporting systems to develop and maintain a variety of statistical reports to support evidence driven improvement across KP; presenting and interpreting quality improvement metric reports to executive management to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical audiences.
• Oversees current and directs future quality improvement and improvement risk management efforts by: implementing corrective action plan for improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys at the executive level to guide long-term strategies and policies; ensuring current and future process improvement initiatives are compliant with established internal and external regulation requirements; utilizing information gathered from root cause analysis, failure mode and effect analysis, and other assessments in response to significant events near misses, and good catches to establish new policies and procedures to mitigate future risk; and defining the standards for escalating high-risk issues and trends at the regional and organizational level.
• Oversees quality improvement performance metrics development, collection, and utilization at the organizational level to guide future policy and strategy.
• Oversees the future direction of quality improvement initiatives and their integration into KP strategy by: driving the long-term direction for the use of technology, methods, and tools to develop stakeholders capabilities for process improvements; serving as the technical advisor to internal and external stakeholders on advanced data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; establishing milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plans that guide the future direction of KP; and consulting with internal and external stakeholders, to define the strategies for quality improvement processes to have consistent design and application of improvement methodologies, use of technology, and prioritization of adaptability.
• Serves as the subject matter expert for quality improvement processes and regulations for executive internal and external stakeholders.
• Oversees and empowers continuous learning in stakeholder development through quality performance review processes by: forecasting and revising the processes and standards for utilization and performance reviews at the organizational level by utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; developing the standards for performance at the organizational level and sets the standards for corrective action plans; presenting performance review reports at the organizational to executive management and external agencies, and advises on the integration of best practices and future performance review needs; and defining the standards for all training and educational programs related to process improvement for quality improvement programs at the organization level.

Qualifications

• Minimum four (4) years of experience managing operational or project budgets.
• Minimum six (6) years of experience in a leadership role with direct reports.
• Minimum two (2) years of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
• Minimum eight (8) years of experience in clinical setting, health care administration, or a directly related field.
• Masters degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum eight (8) years of experience in health care quality assurance/improvement or directly related field OR Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum ten (10) years of experience in health care quality assurance/improvement or directly related field OR Minimum thirteen (13) years of experience in health care quality assurance/improvement or a directly related field.

Certifications & Licenses

• Professional in Patient Safety Certificate within 24 months of hire OR Professional Healthcare Quality Certificate within 24 months of hire OR Professional in Healthcare Risk Management Certificate within 24 months of hire
• Registered Professional Nurse License (Georgia)