Shape the future of healthcare in the underserved community
About the Role
Legacy Community Health is seeking a strategic and passionate Senior Director of Quality Management who will ensure smooth operations, financial stability, and high-quality performance of our Health Outcomes Department, based on a Value-Based Care model. The incumbent will be responsible for quality improvement, risk management, and ensuring regulatory compliance across all Legacy facilities. This role requires a deep understanding of Medicare (our top concern) and Medicaid processes, with a strong preference for a nursing background. The ideal candidate will be data-driven, dedicated to quality improvement, and an effective communicator capable of presenting complex strategies to diverse audiences.
About Legacy Community Health
Legacy Community Health, an inclusive organization with a diverse staff and leadership team, is passionately committed to providing care to all in the community, regardless of their ability to pay.
As the largest full-service Federally Qualified Health Center (FQHC) in Texas and the 5th largest in the USA, we pride ourselves on our dedication to quality care and fostering a supportive work environment.
- Medicare Operations and Compliance: Manages Medicare-related activities encompassing the development and implementation of Medicare Stars strategies and performance improvement initiatives. Also responsible for executing the local Medicare Stars work plan, with interventions aimed at enhancing HCC coding, Clinical Documentation, CAHPS, HEDIS, and HOS scores. Monitors Part D and Operational health insurance metrics, coordinating with centralized teams for improvement. These efforts directly tie to Legacy's commitment to quality and value-based care.
- Medicaid Management and Compliance: Oversees Medicaid annual HEDIS metrics. This includes optimizing provider performance and coordinating with relevant teams to improve outcomes and efficiency in services provided to Medicaid populations.
- Operations, Financial, and Quality Performance Management: Ensures high-quality performance of Legacy's Health Outcomes Department based on a Value-Based Care agreements to ensure MLR target are meet to realize shared savings.
- Quality Improvement and Risk Management Oversight: Directs and supervises all quality improvement and patient safety initiatives for Legacy facilities.
- Quality Strategy Leadership: Acts as the lead for Legacy's Quality strategy, including heading Quality Improvement committee and activities focused on improving quality measures and outcomes.
- Quality Team Supervision: Directly manages the Quality team, offering guidance, feedback, and support as necessary.
- Data Collection and Reporting Collaboration: Works with internal and external customers to perform data collection, reporting, and monitoring for crucial Quality performance measurement tasks.
- NCQA Accreditation and QI Compliance: Manages the execution of NCQA accreditation surveys, expands PCMH certification to all clinics, and UDS (Uniform Data System) compliance operations.
- Quality Performance Metrics Collaboration: Collaborates with other departments to ensure accurate data collection and reporting of quality performance metrics such as CMS Quality Payment Program metrics, Star Ratings, and standardized HEDIS.
- Quality Intervention Strategy Design: Designs, implements, monitors, and analyses the effectiveness of a comprehensive Quality intervention strategy while facilitating stakeholder input and strategic direction.
- Operations and Implementation Leadership: Acts as the operations and implementation leader for Legacy's quality improvement activities using a defined roadmap, timeline, and key performance indicators.
- Communication with Leadership: Maintains regular communication with the CPoH, and Legacy Senior Leadership Team regarding key deliverables, timelines, barriers, and escalated issues requiring immediate attention.
- Collaboration with Analytics Department: Collaborates with the Analytics department for comprehensive quality data analytics and HEDIS abstraction for required VBC custom reports.
- Quality Strategy Presentation: Presents summaries, key findings, and action steps related to Legacy Community Health's quality strategy to key stakeholders.
- Policy and Procedure Creation Assistance: Assists in creating policies, procedures, and standard operating procedures.
- Promotion of Smooth Operations: Promotes efficient day-to-day department operations through ongoing assessment of staffing needs, volumes, utilization of various resources, and funding.
- Quality Management Expertise: Serves as a subject matter expert for quality management efforts within Legacy.
- Integration of Quality Metrics: Integrates quality metrics associated with PCMH certification, various grants, MCOs, and other payers into integrated care management efforts.
- Complaint Handling: Manages complaints related to the functioning of the Health Outcomes Support and identifies appropriate actions to prevent further incidents
- Staff Meeting Conduction: Conducts monthly staff meetings for the Health Outcomes Support Department, reviewing work progress, integrated care dashboards, and other reports related to the department.
Key Performance Objectives:
- Quality Metrics Improvement: Aim to significantly enhance the HEDIS score, CMS Quality Payment Program metrics, and Medicare Stars rating.
- Inter-Departmental Collaboration Improvement: Increase the number of collaborative projects with other departments to foster better interdepartmental synergy.
- Compliance Enhancement: Achieve absolute compliance with all program requirements, state and federal regulations, and Managed Care Organization contract stipulations.
- Communication with Key Stakeholders Improvement: Increase the frequency of quality strategy reporting to key stakeholders for more effective engagement and transparency.
- Patient Centered Medical Home (PCMH) Standards Enhancement: Improve the metrics pertaining to PCMH certification.
- Patient Experience Improvement: Work towards improving CAHPS scores to enhance patient satisfaction and experience.
- Medicare Health Outcomes Enhancement: Aim for improvement in HOS scores over the next year.
- Departmental Operations Strengthening: Regularly evaluate and optimize staffing needs, volumes, utilization of various resources, and funding to streamline departmental operations.
- Strategic Thinking: The best leaders in this role don't just manage quality on a day-to-day basis. They develop a long-term, strategic vision for quality management that aligns with the organization's overall strategic objectives. They can anticipate future trends and challenges and prepare for them proactively.
- Communication Skills: The top performers are exceptional communicators. They can effectively translate complex quality metrics and regulatory guidelines into understandable terms for diverse stakeholders, including executive leadership, staff, patients, and regulatory bodies. They are able to build consensus and drive team-wide commitment to quality improvement.
- Data-Driven Decision Making: The best directors are able to leverage data to drive decision-making and continuous improvement. They understand how to analyze and interpret complex data sets, identify trends, and use this information to develop effective quality improvement initiatives.
- Leadership Abilities: Top performers in this role are strong leaders who can motivate and inspire their teams. They set clear expectations, provide constructive feedback, and foster a culture of accountability and continuous improvement.
- Collaboration and Relationship-Building: The best individuals in this role are adept at building and maintaining strong relationships across the organization. They collaborate effectively with other departments and stakeholders, ensuring alignment of objectives and a unified approach to improving patient care and outcomes.
- Understanding of Regulatory Requirements: The best individuals have a deep understanding of the regulatory landscape, including state and federal regulations, Managed Care Organization contract requirements, and Patient Centered Medical Home (PCMH) standards. They ensure that their organizations are always in compliance with these requirements.
- Patient-Centric Approach: Top performers keep the patient at the heart of all decision-making. They understand the importance of patient satisfaction and experience, and they strive to ensure the highest standards of patient care.
- Innovation and Adaptability: The healthcare industry is continuously evolving. The best individuals in this role are open to change, eager to learn, and consistently looking for innovative solutions to improve quality of care and patient outcomes. They adapt quickly to changing circumstances and regulatory environments.
- Resilience and Problem-Solving Skills: The best directors of quality management demonstrate resilience in the face of challenges. They are able to troubleshoot complex issues, take decisive action, and lead their teams through periods of change and uncertainty.
- Professional Development and Continuous Learning: The best individuals are committed to continuous learning and professional development. They stay updated with the latest best practices in quality management and healthcare, and they seek out opportunities for further training and education.
Perks & Benefits:
Legacy Community Health offers a comprehensive benefits package, which includes:
- Medical, Dental, and Vision insurance.
- Long-Term Disability insurance and Life insurance with AD&D.
- 403(b) Retirement Plan.
- Employee Assistance Plan.
- Subsidized Gym Membership.
- 24-hour Travel Assistance.
- Paid Time Off (PTO) and Company Holidays.
- Bereavement Leave.
- PTO Exchange Benefit: Convert a portion of your accrued but unused PTO hours for use toward several benefits such as 403(b) retirement contributions, student loan payments or tuition, and leave sharing donations to fellow employees.
- Bachelor's degree in healthcare management, nursing, or a related field is required.
- Minimum of 7 years of experience in a healthcare quality management role, with at least 5 years in a leadership position.
- Experience and deep knowledge of Medicare processes is required.
- A Passion for and Experience with Value-Based Care.
- Strong understanding of HEDIS, CMS Quality Payment Program
Legacy Community Health is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace.