Director, Quality & Outcomes Management

Position Summary

Provides leadership for Quality Improvement, Outcomes Management, Social Work, Palliative Care and External Regulatory Agency compliance activities.

 Participates in formulating policy, in setting management objectives, and evaluating programs. Maintains a supportive working relationship with the Medical Staff and other departments within the multidisciplinary healthcare team.

Essential Duties and Responsibilities:

• Leads establishment and implementation of Quality Improvement, Outcomes (Care/Utilization/Clinical Documentation) Management, Social Work, and Palliative Care program.

• Provides leadership for the management of department staff assuring effective  utilization, productivity, development and performance.  Develops budgets for these areas and ensures that operations are within budget.  Participates in decisions to employ, develop, evaluate, transfer, and when necessary, terminate subordinates.

• Provides leadership for the development and implementation of the Performance Improvement Plan.

• Assures that the principles of the Performance Improvement Plan drive all Quality Improvement activities within the System. Assures that staff are educated on principles, tools, and concepts to support Quality Improvement, Outcomes  Management, and Palliative Care. Responsible for continuous program evaluation and the identification of opportunities for maximizing performance and outcomes in assigned areas.

• Assures Core Measures are appropriately monitored and reported in accordance with regulatory compliance

• Collaborates with VPMA and medical leadership to enlist the active support and participation of the medical staff in supporting utilization management priorities, systems design and program goals, and established outcomes.
  
• Coordinates monthly Performance Improvement Council (PIC). Assures reports are provided to Medical Leadership and Joint Conference Committee.

• Coordinates hospital preparation for Joint Commission( TJC).  Maintains an ongoing database delineating plans to ensure compliance with TJC. Performs annual Periodic Performance Review.

• Facilitates the hospital’s compliance with External Agency requirements by coordinating site visits, routing updated requirements to appropriate individuals, coordinating responses to identified deficiencies, and communicating unresolved issues to appropriate Administrative Staff.

• Directs Outcomes Management Program inclusive of Utilization Management, Clinical Documentation, Discharge Planning and Palliative Care.

• Collaborates with Revenue Cycle to minimize denials and assure appropriate length of stay for all patients.   Interfaces with Third party payers as requested.

• Maintains knowledge of changes in the health care industry with special emphasis on Quality Improvement, Outcomes Management, and External Regulatory Agencies requirements. 

• Maintains Outcomes Management Data base inclusive of reviews, denials, case mix and other utilization management activities.

• Serves on selected Hospital, Medical Staff and System Committees as requested.

• Performs other duties as assigned.

• Masters degree in Hospital Administration, Business Administration or Health related field.

• Registered Nurse with 5-10 years experience in acute care setting with progressively responsible program-management experience.

• Ten years of progressively responsible program-management experience. Certified Professional in Healthcare Quality (CPHQ) desirable.

• Knowledge of concepts, principles, tools, and applications of Quality Improvement, Care/Utilization Management, Social Work, and hospital related regulations from both a regulatory agency perspective as well as local, state, and federal requirements.

• Effective written and verbal communication skills.  Strong interpersonal skills necessary for contact with all levels of professionals within the hospital, and from outside organizations and agencies.

• Highly motivated and possessing the ability to deal with people fairly.

• Strong leadership skills, and an energetic approach to the responsibilities of the position.

• Ability to lead, coordinate and implement the work and activities of other individuals      and committees.