Director, Payer Quality Performance

Job Description
General Summary
This role will be responsible for the direction, program management and evaluation of quality performance measures. They will guide a team that identifies trends and make recommendations for clinical and operational quality improvement initiatives. Responsible for the management of quality reporting and compliance for multiple payer programs across the enterprise organization. This position supports the design, implementation, and maintenance of a comprehensive provider network/population health quality performance strategies that includes aligning multiple physicians and UMMS systems. This includes organizing and managing teams, developing project plans and schedules, managing issues, risks, costs, managing to schedule and scope and communicating at all levels of the organization. Manage staff during all aspects of the quality measure life cycle. This role should function as a recognized mentor, quality and regulatory role model. Provides clinical outcomes expertise through analysis of population health data (clinical quality measures) extracted from practice EHR, payer data and patient experience data. Serves as a lead in identifying health care trends in health outcomes, utilization, population and disease management, and patient experience. Partners with end users to identify their reporting needs and solutions.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Serves as a leader between population health/payer quality programs;
prioritizes problems for effective and timely resolution, and develops/communicates resolution plan/approach and recommendations.
2. Provides operational leadership to payer quality and population health programs and staff, while able to seamlessly manage projects as indicated leadership.
3. Responsible for managing assigned teams (internal staff as well as team members in other departments) to ensure project plan objectives remain on target and are achieved in accordance with the action plan deadlines
4. Oversees implementation plan development and coordination of resources to execute the plan In conjunction with clinical and administrative leaders, develops key priorities for advancement of clinical integration relative to program development and clinical quality improvement
5. Supports system-wide governance and committee infrastructure for payer quality programs
6. Works closely and in collaboration with leadership throughout organization, including practice transformation, clinical integration, finance, payer relations, performance improvement, care management, patient experience, marketing and communications, internal and external partners to set the strategic direction for program development, performance improvement and resource deployment
7. Understands UMMS population health vision, goals and strategies and communicates to others. Able to set clear goals and directions.
8. In conjunction with local hospital and practice quality leaders and clinical integration, supports the development of population-based registries, clinical practice guidelines, and evidence-based quality measures aimed at establishing, measuring and monitoring a high standard of clinical excellence for our patients.
9. Regularly communicates progress and impact to key stakeholders and senior leaders through KPIs and other scorecard tools.
10. Determines staffing requirements and directs the work of all direct reports to ensure effective and efficient departmental functions. Serve as resource, primary advisor, and mentor for all direct reports and cascading teams.
A. Hires, orients, trains, conducts performance evaluations, handles disciplinary issues, and provides an open and goal oriented work environment with establish clear and concise work procedures and productivity standards. Conducts performance reviews, and holds employees accountable for optimal performance of their responsibilities.
B. Develops personnel by providing opportunities and training programs to enhance individual employee’s career development.
C. Ensures full staff competency of technologies, regulations, policies and practices across the division.
D. Manages activities of contractors.
11. Implements and enforces departmental policies and procedures.
A. In coordination with departmental management, ensures compliance with regulatory and audit agency requirements.
B. Develops performance improvement initiatives aimed at improving customer service, operating costs, departmental functions/departmental productivity.
C. Develops and executes effective control process and compliance monitoring procedures to ensure risks are measured, monitored, controlled, and mitigated.
D. Represents the department at various meetings, task force groups, quality councils and with other members of the UMMS/QCN.
12. For complex projects or programs, direct the initiative using best-practice program management approaches to deliver against approved estimates for quality on-time and on-budget programs and projects.
13. For programs consisting of multiple subprojects, directs the deployment and organization of resources, including the mentoring of project coordinators and project managers. Ensure development of timetables and targets and check progress against them. Direct the plans of activities;
ensures a plan which streamlines the program process.
14. Meet with stakeholders and executive to review solution and issues and to gain commitment on recommendations related to quality payment programs.
15. Exhibits mastery of reporting projects, data manipulation and analysis related to quality payment programs. Provides mentorship.
16. Direct project managers to use the commonalities/differences within the team members’ goals, values and problem-solving styles to generate multiple alternatives in leading group to achieve a result and monitor for effectiveness. Ensure program impact does not negatively impact or interfere with others.