Clinical Quality Improvement Team Lead

Company: PacificSource
Location: Portland
Posted on: May 28, 2023

Job Description:

Clinical Quality Improvement Team Lead page is loaded Clinical Quality Improvement Team Lead Apply locations Portland, OR time type Full time posted on Posted 2 Days Ago job requisition id 2023-911 Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. Position Overview: This position will have direct oversight and supervision of the Quality Improvement Coordinators that are part of the Clinical Quality Improvement program. Work involves collaborating with Health Services and other internal departments to plan and implement value aligned quality improvement programs, projects, and interventions across all lines of business, while ensuring programs maintain regulatory compliance. This work will deliver on the triple aim of improving the member's experience of care, improving the health of populations and reducing the cost of health care. Essential Responsibilities:

• Provide supervision, training, and support to assigned staff. Conduct performance management and assist with hiring, staff development, and employee retention.
• Evaluate performance of team members. Analyze results of performance reports for each team member to determine training needs related to personal performance and department goals.
• Lead quality improvement projects and work plans by assisting team with the identification of new clinical improvement opportunities through data analysis and interpretation, create alignment between projects and work plans where applicable, and ensure compliance with federal, state, and program regulations.
• Lead and participate in the development and implementation of state Performance Improvement Projects (PIPs), Transformation and Quality Strategies (TQS), CMS Chronic Condition Improvement Program (CCIP), Quality Improvement Strategy (QIS) and applicable annual program evaluations.
• Accountable for timely and accurate completion of regulatory quality activities. Present progress and results to senior and executive level management, as needed.
• Provide leadership on quality activities and discussions where expertise is required.
• Support Leader Standard Work through setting goals and metrics, visual management, idea boards, huddles, 1:1s with team members, and regular team meetings.
• Manage internal and external quality audits by preparing, editing, and reviewing response documentation. Be present and an active participant in response sessions.
• Develop and manage Clinical Quality policies and procedures. Ensure annual review timelines are met and policies and procedures are relevant, up-to-date, and compliant.
• Represent Clinical Quality team in company and community quality programs and projects.
• Develop, write, and present specialized quality reports.
• Review Quality Improvement Coordinator's reports for accuracy, and compliance with internal writing standards and external regulatory compliance.
• Stay current on quality measures, quality projects, and regulatory requirements across all lines of business.
• Represent the health plan in the communities and regions we serve to build collaborative partnerships.Supporting Responsibilities:
  • Coordinate business activities by maintaining collaborative partnerships with key departments.
  • Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  • Meet department and company performance and attendance expectations.
  • Lead and/or support quality improvement activities, designated committees, and/or task forces to ensure the delivery of quality, cost-efficient, high quality member care.
  • Build partnerships by interfacing with community stakeholders and provider community to promote all aspects of high-quality clinical care. -
  • Represent PCS in quality capacity at community, statewide and regional meetings to create and implement quality improvement policy, projects, and interventions.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned. SUCCESS PROFILEWork Experience: Five years of experience in healthcare or public health with varied clinical focus is required. Minimum of three years health plan experience focused on program development, quality improvement, and application of state or federal regulations. Strong technical writing skills. Experience implementing and managing any of the following is strongly preferred: disease management, chronic condition management, case management, health promotion, program development. Prior leadership or supervisory experience preferred.Education, Certificates, Licenses: Master's degree in Public Health or other related field required. -Knowledge: Knowledge and understanding of health insurance, disease prevention, care modalities, and procedure codes (including ICD-10, CPT, and HCPCS codes). Knowledge of NCQA standards and Medicaid and Medicare regulations. Familiarity with CMS Stars, NCQA HEDIS metrics and state quality incentive measures. Knowledge of quality improvement methodology. Ability to develop, review, and evaluate utilization reports. Strong analytical and problem-solving skills. Proven project management experience, thorough understanding of health care operations, process improvement, business analysis and program planning and evaluation. Experience giving presentations. Strong organizational skills and attention to detail. Solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Familiarity with population health and data management platforms. Ability to work independently with minimal supervision.Competencies
    • Building Trust
    • Building a Successful Team
    • Aligning Performance for Success
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Continuous Improvement
    • Decision Making
    • Facilitating Change
    • Leveraging Diversity
    • Driving for ResultsEnvironment: Work inside in a general office setting with ergonomically configured equipment. Occasional overnight travel.Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
      • We are committed to doing the right thing.
      • We are one team working toward a common goal.
      • We are each responsible for customer service.
      • We practice open communication at all levels of the company to foster individual, team and company growth.
      • We actively participate in efforts to improve our many communities-internally and externally.
      • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
      • We encourage creativity, innovation, and the pursuit of excellence.Physical Requirements:Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. -Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. Similar Jobs (1) Utilization Management Clinician - Behavioral Health locations Portland, OR time type Full time posted on Posted 15 Days Ago PacificSource is anything but a typical health insurance company. Founded in 1933, we're an independent, not-for-profit organization that puts our members, and their communities first-across Idaho, Oregon, Montana, and Washington. It's our 1,800+ employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first-more than 600,000 of them-initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: F lexible telecommute policy, m edical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. Why PacificSource We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here's what else we feel good about:
        • A mission with a real sense of shared values
        • Competitive wages and outstanding benefits, including telecommuting
        • Opportunities for learning development and career advancement
        • Organizational leadership style rooted in servant and transformational leadership
        • A commitment to support the communities we serve
        • A belief in the importance of work-life balance Upcoming career fairs
          • June 20: Health Worker Regional Workforce Summit, all day at Bend COCC Coats Center (2600 NW College Way in Bend, OR)
          • August 17: Idaho Business League Job Fair, 10 a.m. - 2 p.m. at Nampa Civic Center in Idaho
          • August 23: Portland Diversity Career Fair, 11 a.m. - 3 p.m. at Portland Expo Center (2060 N. Marine Drive in Portland, OR) Grow your career with us PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2022 alone we had 421 internal promotions! Recognitions
            • Certified Age Friendly Employer, 2023 - Age Friendly Institute
            • Top Workplace 2022 for Idaho - Idaho Press
            • Top Workplace 2022 for Oregon and SW Washington - The Oregonian
            • #4 Healthiest Employer of Oregon 2021 - Portland Business Journal
            • Healthy Worksite 2021 - Design Coalition in Montana Affirmative Action Program Policy Statement PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. Get in touch If you have questions about working at PacificSource or need help with your application, please email HR@PacificSource.com .

Keywords: PacificSource, Portland , Clinical Quality Improvement Team Lead, Healthcare , Portland, Oregon