GENERAL SUMMARY: This role is responsible for leading and managing quality improvement initiatives impacting core clinical processes and critical patient care functions. Works collaboratively with executive leadership, administrators, managers and physicians to identify and enhance strategic clinical issues which improve performance on quality, cost and experience metrics for both internal and external customers.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Collaborates with Value Programs team to plan and execute on QI initiatives, with emphasis on formalized, data-driven improvements to performance on contracted priorities. Examples of QI initiatives include: closure of care gaps, improving clinical outcome measures, and optimizing workflows for capture of relevant clinical information.Engage in periodic review of program data reflecting performance and outcomes.Serve as team QI leader and coach, maintaining familiarity with multiple QI methodologies, tools and data models to support and promote team improvement efforts.Facilitates quality improvement and practice transformation efforts through collaboration with clinic staff, sharing expertise in best practices as well as preparing and communicating information to clinics on their performance, data sources, and provider incentives to drive results. Design and maintain data collection processes related to QI projects, including creation and management of files, spreadsheets, reports, agendas and graphics.Collects data, conducts analysis, synthesizes findings, and communicates results, variances and opportunities for improvement for various quality measures. Collaborate across UPG and the Health System, as well as with external quality improvement networks, to develop and implement QI best practices.Prepare and/or represent team accomplishments to UPG and Value-Based leadership.Assist in establishing and partnering with value-based advisory groups and clinic/Department leadership to enhance communication and engage in shared decision making.Work with stakeholders to develop relevant in-person and online educational trainings on priority HEDIS quality measures, complex diagnosis documentation for improved risk adjustment, and best practice EPIC workflows to ensure patient needs are met.Collaborate with participating ambulatory clinics and stakeholders to establish relationships, observe clinic operations/workflows, as well as implement and track quality improvement strategies to optimize quality metric performance.Maintains thorough knowledge and understanding of the HEDIS quality measures, their nuances and the specifications to adequately speak in depth.Support Quality Improvement leaders and other internal staff to identify and implement strategic internal and community initiatives aimed at maximizing member outcomes and performance results.Functions as a leader for assigned quality improvement initiatives handling multiple large-scale complex initiatives, focusing on QI, Medicare Star Ratings, HEDIS and Risk Adjustment. Prepare implement and monitor regional work plans to ensure clinical and service quality improvement programs are carried out, providing feedback to internal and external stakeholders.Under the direction of the Practice Innovation Medical Director, leads/facilitates multi-department/cross-functional quality-focused collaboratives and workgroups which support key initiatives.Collaborate with provider partners to identify data sources, provide technical assistance on use of data and reporting systems to drive performance improvement.Collect, organize, and share data and information between external and internal stakeholders, including how practices implement process improvements.Assist with the evaluation of initiatives to determine the effectiveness and make recommendations to improve outcomes.Synthesize customer and third-party feedback into operational solutions that drive on-going enhancements to member experience.Participate in relevant community partnerships and workgroups.Other duties, as assigned.

REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):

Education and Licensure:

Bachelor’s Degree in Health Care Administration, Business Administration, Nursing, or related degree.  Master’s degree preferred.Graduate of an accredited program of clinical specialty; i.e. MD, DO, RN, Pharmacy, Social Work or Therapy Services preferred.

Experience: 

Minimum of five (5) years in healthcare with a strong clinical focus. Experience in quality improvement, practice facilitation and project management required.  Prior management experience preferred.

Skills:

Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences. Experience giving presentations.Proven ability to interpret and present clinical data to clinical professionals.Able to form strong working relationships and be highly collaborative across multiple internal and external stakeholders. Strong analytical and critical thinking skills, including comfort with analyses to support data-driven recommendations.Organizational and analytical skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Demonstrated ability to lead activities, manage tasks, and coordinate the work of multidisciplinary teams to deliver high-quality work on time.Knowledge and understanding of disease prevention, medical procedures, care modalities, procedure codes, including ICD-10, CPT Codes, compliance guidelines/regulations and health insurance. Ability to develop, review, and evaluate data and performance reports. Knowledge of quality improvement and Clinical Documentation Improvement (CDI) methodology. Ability to work independently with minimal supervision.Advanced understanding of the relationship between hospital and clinic workflows to clinical documentation and data collected, in particular with Epic Systems.Strong oral and written communication skills with proven ability to effectively interact with all levels of management, staff and providers.Thoroughness, accuracy and attention to detail.Excellent troubleshooting skills.Demonstrated aptitude for learning new technologies.Some day travel within the Commonwealth of Virginia (approximately 25%) required.

SUPERVISORY RESPONSIBILITIES:  The incumbent will have