DIRECTOR OF QUALITY

The Director will lead, monitor, implement and evaluate RHS quality, performance improvement, and population health processes to improve healthcare outcomes. Coordinates Quality Improvement Committee, medical staff quality improvement activities, and process improvement teams. Educates and facilitates management and staff education regarding process improvement. Assures regulatory agencies, IDPH, CMS, HCFA, and other governmental regulatory bodies. Represents RHC at Rush System for Health quality meetings on a monthly basis.

The Director will be instrumental in designing and implementing key quality and population health priorities. The Director will work on programs and interventions, targeted to the right patients, to improve quality and cost of care. The Director will work collaboratively across the continuum. Working side by side with physicians, advance practice providers, and care team members. This will require building relationships with clinicians, including primary care physicians, nurse practitioners, pharmacists, psychiatrists, registered nurses, licensed clinical social workers, and others. The Director is responsible for contributing to the growth and profitability by professionally managing services and activities for the organization's Population Health Management Program. This position is responsible for providing the oversight and direction for designing, implementing and supporting a system-wide population health management program, that is aligned with the \"\"Triple Aim.\"\" The Director will work alongside various departments including clinical operations, Analytics, IT, Finance and payers contracting to assure alignment of care management practices. The Director will assist ongoing education for the health system to ensure quality of care.  

The Director is responsible for the development, implementation and ongoing review of the continuum of care and integrated case management system for an identified population of patients. This position will collaborate with and engage senior management and physician leadership, and other staff throughout the organization to implement the population health program and promote a culture consistent with Riverside Healthcare's mission, core values and standards of conduct. The Director will be highly visible to ensure that we are driving innovation and improvement rapidly and consistently within the continuum.  

Essential Duties

• Directs, oversees and coordinates the performance improvement and quality efforts of RHC
• Identifies, evaluates and incorporates best practices and innovative emerging technology trends to enhance quality, reduce cost, improve network operations and provider engagement to drive desired outcomes
• Provides organizational leadership and direction by developing, monitoring and implementing metrics and performance targets that assess compliance with CMS, Rush Health, HEDIS and other regulatory agencies to improve health care outcomes at RHC
• Coordinates improvement activities for successful accrediting, licensing, recognition and certification surveys
• Assures that quality assurance audits are completed in a timely fashion and are reported back to the audited entity within the required timeline
• Builds and supports effective relationships with internal and external stakeholders and organizations. Working collaboratively with the CMO, CNO, Nursing Management team on organizational quality and population health initiatives, workflows and metrics
• Reviews, prepares, analyzes and presents reports and recommendations to senior leadership regarding performance, operations, programs, services and other applicable areas of interest in order to provide concise and accurate information that aides in decision-making
• Manages day to day operatons of the Quality Improvement dept
• Manages, educates and maintains the policy and procedure database for RHS
• Participates and contributes to assigned committees, teams, task forces including community service if applicable
• Participates and leads quality teams
• Prepares and facilitates the Quality Improvement Committee meetings
• Serves as a resource and educates management, staff and medical staff on the principles of performance improvement and case management and utilization management activities for RHS
• Oversees the Stroke Coordinator for the medical center and facilitates the stroke program in conjunction with the MEdical Director and Stroke Team with the responsibility for ensuring that the requirements of the PSC program are implemented and maintained
• Satisfactorily complete all required continuing education hours regarding the care of acute stroke patients.
• Design and implement workflows for the collection of roster information and operational workflows to act upon the information at the clinic level
• Implement processes to identify patient who require Chronic Care Management, transitional care or other continuum services to ensure the highest quality of care meeting patient's clinical needs
• Acts as a liaison between departments such as providers, Analytics, Finance, Quality, Admitting, Marketing, Clinical Teams, and payers to facilitate contract implementation and resolve issues
• Accountability to key population health metrics including quality measures, utilization measures and financial measures
• Evaluates effectiveness of performance improvement program, obtaining input from administration, staff and medical staff
• Manages and provides leadership in financial matters regarding budgeting and cost control and revenue generation
• Assures regulatory compliance

Required Experience

• Clinical background in nursing or other patient care profession is required
• 5+ years of quality improvement in a health system with knowledge of regulatory body requirements
• 3+ years of applicable experience in healthcare/population health/working with healthcare providers; or payers or other similar fields
• Strong leadership skills and strong influencing skills
• Strong analytical skills
• Understanding risk payment environment
• Someone who connects the dots between departments - a proactive communicator who puts individual projects into broader organizational objectives
• Strong knowledge in MS Office Excel

Required Licensure/Education

• Master's degree required
• Current state licensure or registration in clinical area of expertise
• Effective 4/01/2024: Upon hire or within 12 months of start date, must complete and maintain a nationally ANCC-recognized nursing leadership or nursing specialty certification.

Employee Health Requirements

Exposure/Sensory Requirements

Exposure to:

• Chemicals: Refer to MSDS sheets
• Video Display Terminals: Average
• Blood and Body Fluids:

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Required to communicate with patient/families/staff/MD's. Needed for presentations/training, telephone communication.
• Vision: Needed to read memos and literature, patient reports and charts.
• Smell:
• Hearing: Necessary to hear alarms, hear patient verbalizations, meetings, telephone communications.
• Touch: Necessary for writing, computer entry, filing.

Activity/Lifting Requirements

Percentage of time during the normal workday the employee is required to:

• Sit: 10%
• Twist: 4%
• Stand: 40%
• Crawl: 0%
• Walk: 25%
• Kneel: 1%
• Lift: 10%
• Drive: 0%
• Squat: 1%
• Climb: 1%
• Bend: 30%
• Reach above shoulders: 3%

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently
• Up to 20 lbs: Occasionally
• Up to 35 lbs: Not required
• Up to 60 lbs: Not required
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required
• Over 100 lbs: Not Required

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 30
• Twist: 15
• Stand: 60
• Crawl: 0
• Walk: 10
• Kneel: 0
• Lift: 5
• Drive: 0
• Squat: 2
• Climb: 1
• Bend: 15
• Reach above shoulders: 2

Repetitive use of hands (Frequency indicated): 

• Simple grasp up to 10 lbs. 
• Normal weight: 5#
• Pushing & pulling - 50-200 lbs: Occasionally
• Fine Manipulation: Typing in computer, omnicell, using pens to chart, drawing up meds in syringe and administration, starting IV's.

Environmental Factors & Special Hazards

• Environmental Factors (Time Spent):
• Inside hours: 8-9
• Outside hours : 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Dry
• Atmosphere: Dust