Job Summary:

Leads the development of quality strategies in alignment with KFHP strategic priorities, mission, and vision. Oversees coordination across areas to recommend actions based on reviews of regional quality reports. Tracks industry trends and identifies new opportunities for improvement and helps establish organizational priorities. Manages the implementation of clinical quality improvement action plans and puts forth recommendations to senior leadership. Establishes key metrics and goals across teams and holds other leaders accountable for ensuring quality issues are identified and resolved. Serves as a subject matter expert for clinical quality processes and regulations for team members and creates processes and tools for others to increase their regulatory knowledge. Manages others to review and act on results of data analysis, monitor corrective action plans, and review and approve quality policies. Guides the oversight of and coordination with the functions of Quality Committees and subcommittees. Leads the annual approval of Quality Program description, work plans, and annual evaluations.

Essential Responsibilities:

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.

• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.

• Serves as the subject matter expert for clinical quality improvement processes and regulations for within departments, facilities, internal and external committees, and key stakeholders by: providing consultation on the interpretation and interaction of current policies and how they interact with the current climate, and potential changes to regulations and legislation; leading committees, projects to influence decisions on the enforcement, development of policies, or procedures of regulations and auditing processes and ensuring accountability for successful implementation of core priorities; fostering collaborative, results-oriented partnerships with practitioners, staff, and/or management across clinical and administrative roles to ensure and advise on organizational capability to remain compliant; empowering educational programs to raise awareness for current and changing regulation requirements, internal concerns, and system/database usage; and identifying systematic barriers which cause issues, and weighing practical, technical, and KP capability to develop corrective actions.

• Manages the quality of care complaints and review process by: directing the grievance meetings, cases, reviews, referrals, and other mechanisms by collaborating with key stakeholders, the ombudsman, and external regulatory services; responding to and directing the preparations of all documentation, records, and information requested for specific patient case reviews; managing the process flow of investigations and claims for red flags and areas of improvement; and monitoring critical quality improvement metrics, cases, quality care incidents, and near misses according to established protocols on a periodic basis.

• Leads the development of infection prevention and control programs to improve employee and patient safety by: prioritizing and managing epidemiological investigations of significant clusters of infection or serious communicable disease concerns as a part of prevention, surveillance, and outbreak management; coordinating outbreak containment efforts within the area of focus; and consulting with Administration on infection control implications of architectural design, renovation, and construction.

• Manages risk management efforts by: leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across departments and regions; enabling others to be compliant with internal and external polices, regulations, and legislation related to quality improvement by interpreting regulations into actionable actions; developing the processes for root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement and evaluate newly internalized processes and programs; and developing the process for escalating high-risk issues and trends to appropriate entity for resolutions.

• Manages patient safety programs and initiatives by: strategizing with relevant teams and leaders to coordinate responses and action plans to address reported significant events including safety hazards, accidents, incidents, and threats; and collaborating with key stakeholders and senior management to develop patient care and satisfaction programs which aim to improve patient flow, clinical support, patient services, and seamless transition of care.

• Manages the development of new clinical quality improvement programs by: developing relationships with departments, key stakeholders, and senior management to identify and develop new programs with guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, analyzing program performance, performance reviews, and peer/department review groups; serving as a subject matter expert for a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and realizing strategic opportunities to develop KPs capacity as a learning organization, increasing capacity in areas such as video ethnography, patient-reported outcomes, and harvesting of best practices.

• Manages the systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs by: ensuring the quality improvement monitoring agenda for assigned departments and regions includes all aspects of data management and analysis of trends and patterns of practice; serving as a subject matter expert on statistical analysis for team members and management for conducting and interpreting quality improvement evaluations; developing the procedures for gathering and entering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and presenting and interpreting reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) in specified formats for internal and external stakeholders, and publishing results accordingly.

• Manages regulatory audits and survey efforts by: serving as the primary contact between applicable government, regulatory, and key stakeholders for onsite visits and evaluations; developing the procedures for preparing requested audit documentation, information, reports, and tools throughout the auditing process; reviewing prepared audit documentation, information, and reports for ad hoc and compels auditing; and leading and identifying areas of improvement for continuous survey readiness and monitoring activities to maintain compliance with regulatory standards and forecast potential needs.

• Manages the evaluation of the cost effectiveness, practicality, and appropriateness of medical care given to patients by: conducting routine case reviews with practitioners; developing and implementing the standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care; overseeing current patient treatment plans to ensure patient needs are met in a timely manner and escalates concerns to key stakeholders; forecasting current and future population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others, and developing projects to ensure those needs are met; and overseeing previous patient cases to identify areas of improvement for length of stay, type of treatment, and time of treatment, and escalating concerns and recommendations to the senior leaders.

  Minimum Qualifications:

• Minimum one (1) year of experience managing operational or project budgets.

• Minimum five (5) years of experience in a leadership role with or without direct reports.

• Minimum four (4) years of experience with databases and spreadsheets.

• Minimum four (4) years of experience delivering training programs.

• Minimum five (5) 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 five (5) years of health care experience or a directly related field OR Minimum eight (8) years of experience in health care or a directly related field.

  Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Negotiation; Risk Management; Compliance Management; Health Care Compliance; Health Care Policy; Health Care Data Analytics; Learning Measurement; Community Health; Health Care Coding; Consulting; Managing Diverse Relationships; Delegation; Development Planning; Project Management; Risk Assessment; Health Care Quality Standards; Quality Improvement; Quality Assurance and Effectiveness; Evidence-Based Medicine Principles; Infection Control

COMPANY: KAISER

TITLE: Senior Manager, Quality and Safety Oversight (KFH/HP)

LOCATION: Oakland, California

REQNUMBER: 1344615

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.