Leads the CQCI clinical team in the identification and prioritization of potential clinical quality, cost, and utilization opportunities that may affect clinical or financial performance of value-based contracts.
Provides clinical leadership, expertise, and knowledge to the CQCI team in the development of strategies to evaluate selected opportunities.
Provides clinical leadership, expertise, and knowledge to identify key drivers of current performance and opportunities for improvement in clinical performance.
Provides clinical leadership, expertise, and knowledge to formulate recommendations for improvement based on the completed analysis.
Collaborates with PHSO, Advent Health and CIN leadership and teams in the implementation of accepted recommendations. Provides clinical leadership, expertise, and knowledge to oversee and carry out the development of evidence-based protocols, clinical pathways and guidelines, and other interventions as needed.
Provides clinical leadership, expertise, and knowledge for the CQCI team to develop and deploy clinically appropriate measures and formats to track improvements and ensure improvements in performance. Participates in ongoing Performance Review Committee meetings as requested.
Responsible for the daily activities and operations of the Clinical CQCI team, including but not limited to oversight of each of the clinical care initiatives and addressing staff related issues/concerns.
Responsible for hiring, training, evaluating and all other human resources functions for the Clinical CQCI staff that report to this role.
Assists in the development and maintenance of policies and procedures as needed to support the CQCI function or regulatory requirements.
Assists in the preparation and management of departmental budgets.
Builds strong relationships with leadership, customers, and peers. Communicates appropriately and effectively with all stakeholders, customers, and supervisors maintaining awareness of any issues, potential delays, and any situation of concern that may affect the timeliness of process implementation.
Responsible for exceptional customer service by promoting an image of a professional high-quality organization through expertise and responsiveness.
Prepares reports, attends meetings, and presents information as requested.
What You Will Need:
Education and Experience Required:
Bachelor’s degree in nursing or public health / epidemiology.
7 years of experience in healthcare.
2+ years of experience in management.
2+ years of experience in managed care or equivalent.
2 years of experience leading a team responsible for healthcare quality and / or analytics.
2 years of experience in healthcare quality and / or analytics.
Knowledge and Skills Required:
Substantial knowledge of health plan operations, managed care principles and practices, network management, and clinically integrated networks.
Substantial knowledge of analytical methods and tools to evaluate clinical quality, utilization, and cost trends for value-based contracts.
Substantial knowledge of advanced performance improvement methodologies including lean six sigma and change management.
Excellent verbal and written communication skills with the ability to communicate clearly, coordinate and work effectively with teams, and tailor messages to individuals and audiences throughout the institution with differing knowledge levels.
High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, physicians
Excellent problem solving, prioritization and operational skills with the ability to make independent decisions and resolve problems.
Strong organizational and management skills.
Ability to manage multiple initiatives to achieve organizational goals.
Proficient using desktop applications and database programs, particularly Microsoft Office (Word, Excel, PowerPoint, and Outlook).
LSS Blackbelt preferred
The Director – Clinical Quality and Cost Innovation (CQCI) for the Population Health Services Organization (PHSO), the value-based insurance division of AdventHealth, leads clinical efforts to identify quality, cost and utilization improvement opportunities and make recommendations for improvement for the value-based contracts held by the Advent Health PHSO and its affiliated ACOs and CINs. This role is a key leadership position providing clinical expertise on the interdisciplinary Clinical Quality and Cost Innovation (CQCI) team related to population health for the system. The PHSO maintains a portfolio of risk with over $2 billion in covered expenses and 425,000 lives across a multistate health system that includes multiple clinical integration networks (CINs) and accountable care organizations (ACOs). This position continuously collaborates with various PHSO departments, the PHSO CINs and ACOs, Advent Health Clinical, Advent Health Medical Group, and various payer / partners.
The Director collaborates with the Executive Director to lead the clinical aspects of the Clinical Quality and Cost Innovation (CQCI) team. The team is responsible for performing detailed research and analysis to identify clinical quality, cost and utilization improvement opportunities within the value-based contracts held by the Advent Health PHSO and its affiliated ACOs and CINs. Based on this analysis, the team develops detailed recommendations for improvement and collaborates with the ACOs and CINs on the implementation and maintenance of accepted recommendations.
Substantial collaboration is critical to the success of these programs. Through these efforts, the PHSO will improve the health and wellness of individual program participants; improve the overall health of value-based populations; and influence the appropriateness of utilization and costs for PHSO healthcare services. The team will work with various stakeholders to improve processes and transform the practice of medicine to reduce variation in how care is designed, provided, and delivered to optimize value-based performance.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.