[Remote] Regional Director, Continuum Contract Quality Oversight

Note: The job is a remote job and is open to candidates in USA. Kaiser Permanente is seeking a Regional Director for Continuum Contract Quality Oversight, responsible for leading quality audits for community vendors and ensuring quality oversight is standardized for members. The role involves developing quality strategies, overseeing clinical quality improvement action plans, and collaborating with various departments to enhance patient safety and satisfaction.

Responsibilities

• Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives
• Directs the quality of care complaints and review process by: directing and representing KP at grievance meetings, cases, reviews, referrals, and other mechanisms; responding to and directing the preparations of all documentation, records, and information requested for specific and highly sensitive patient case reviews; reporting trends in the process flow of investigations and claims for red flags, appeal reasons, and overturns, reporting results, and advising on strategic direction; and defining the standards for the surveillance of quality improvement metrics, cases, quality care incidents, and near misses according to established protocols to ensure equal/consistent application of KP policies
• Directs risk management efforts by: defining the standards for corrective action plan for improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across the organization; defining the standards for root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches; defining the standards for escalating high-risk issues and trends to appropriate entity for resolutions; and defining the standards for health outcome analysis to continuously monitor oversight effectiveness
• Oversees patient safety programs and initiatives by: directing significant event management and response to safety hazards, accidents, incidents, threats, and significant events; and collaborating with executive management and external personnel to develop patient care and satisfaction programs which aim to improve patient flow, clinical support, patient services, and seamless transition of care
• Oversees development of new clinical quality improvement programs by: maintaining relationships with key stakeholders, senior management, peers of other markets, and external stakeholders to set the standards for new program guidelines, metrics, and operational definitions of quality improvement, and ensuring the sustainability of the program; serving as a subject matter expert on a variety of health concepts, regulatory requirements, and change management principles to foster the development of programs that optimize clinical quality, safety, or health outcomes; and providing insight into KPs capability of realizing strategic opportunities to develop as a learning organization by advocating for the program and consulting with senior management, technology stakeholders, and external vendors
• Oversees regulatory audits and survey efforts within region by: serving as the primary contact between applicable government, regulatory, vendors, and key stakeholders or onsite visits and evaluations; developing the processes for implementing the standards for audit documentation, information, reports, and tools throughout the auditing process; reviewing prepared audit documentation, information, and reports for ad hoc and complex auditing; and directing continuous survey readiness activities to maintain compliance with regulatory standards to adapt to changes in regulatory and KP requirements

Skills

• Minimum two (2) years of experience managing operational or project budgets
• Minimum seven (7) years of experience in a leadership role with or without direct reports
• Minimum five (5) years of experience with databases and spreadsheets
• Minimum four (4) years of experience delivering training programs
• Minimum seven (7) years of experience in clinical setting, health care administration, or a directly related field
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum seven (7) years of health care experience or a directly related field OR Minimum ten (10) years of experience in health care or a directly related field
• Professional Healthcare Quality Certificate within 24 months of hire OR Professional in Healthcare Risk Management Certificate within 24 months of hire

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