POSITION SUMMARY

With direction from the Chief Health Officer, the Director of Quality and Population Health (DQPH) will function as the assistant lead for Quality at Swope Health (SH). He/she will be responsible for recommending changes and enhancements to quality processes based on extensive knowledge in health care delivery systems, utilization, reimbursement methods and treatment protocols. In conjunction with the Chief Health Officer the DQPH, apprises Quality and Population Health staff members of current trends and developments in population health and quality. In addition to assisting with oversight of utilization review (UR) and quality management (QM) processes and initiatives, the DQPH will also assist with the overall responsibility of assuring the cost-effective delivery of services for SH. To enhance ongoing SH relations, the DQPH will need to function as liaison to the population health community. The DQPH will help the organization meet the quadruple aim of improving the patient and care team experience, improve population health, and cost effectiveness.

Primary Functions

• Responsible for oversight of population health initiatives including the supervision of personnel assigned to these functions. These include but are not restricted to care coordination, nurse care management, chronic disease management, integrative care services, dietetics and other applicable programs.
• Responsible for standards and accreditations including the coordination of joint commission, HRSA, PCMH and other outside agencies and the supervision/coordination of the personnel assigned to these functions.
• Responsible for the development and management of the peer review process in accordance with best practices.
• Makes recommendations for use of laboratory, radiology, pharmacy and other professional services to SHS Leadership.
• Assists in developing specific orientation and mentoring programs for quality department personnel with regards to patient management.
• Assists in the development and delivery of health education and continuing education for clinical staff.
• Assists with the design and implementation of protocols for quality management.
• Assists in the supervision of medical audits and review of practice patterns to assure adherence to quality standards and utilization criteria.
• Assists with quality reports and presentations to SHS Leadership, Board of Directors and the Swop Associates.
• Works with the medical informatics team to ensure adequate reporting, mapping and validation of quality measures.
• Assist with organization wide integration of care efforts including but not restricted to incorporating health equity, trauma informed care into mainstream clinical care.
• Assist with supervision of Quality improvement projects for medical students, doctorate students, nursing students and physician residents rotating at Swope Health.
• Standardize Quality and Performance Improvement initiatives at Swope Health.
• Work closely with managed care programs and other insurers to meet goals for value based care and other performance metrics.
• Work closely with Chief Operating officer, Department leads and Director of nursing to meet quality related KPIs as outlined in the Quality and strategic plan.
• Track, report and develop systems to improve patient feedback response rates, and the overall patient experience.
• Other duties as assigned by SHS Leadership.

Clinical Responsibilities/Key Competencies

• If the role is filled by a physician or clinical provider then will perform clinical duties to provide direct patient care for minimum of 40% or as directed by the Chief Health Officer.
• In conjunction with the CHO and SH Leadership, ensures that all quality and population health personnel comply with applicable local, state and federal regulations, and all policies, procedures and directives of the organization and contracted third party payers.
• Assists SHS Leadership in reviewing the Quality, Population Health and Patient Safety Program.

• Active participation in systems and administrative meetings.

• Responds to patient/associate complaints and educates regarding SHS’s plans and policies as needed.

• Performs other assignments as requested by the Chief Health Officer.

• Carries out other administrative/operational assignments as requested by SHS Leadership.

Qualifications

• Doctor of Medicine (M.D. or D.O.) licensed in the States of Missouri and Kansas, or RN with Masters required.
• Certification in Medical Quality, or Health Care Quality or/and Master’s in Public Health preferred.
• Three to five years as an administrator in a community health center, public health, ambulatory practice or managed care setting preferred.