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J190218

Director Of Quality & Practice Transformation

Allegheny Health Network

  • Company AHN
  • Pittsburgh, PA
  • Patient Support
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This role is responsible for the successful implementation of the AHN enterprise-wide Quality goals and objectives for designated locations. Oversees the Quality function, while working in tandem with other Quality and Safety Divisions such as: Patient Safety, Infection Prevention, Regulatory Preparedness, and Pay for Value. Accountable for driving results to achieve top performance for all clinical and pay for value measures which may include but are not limited to: P4V program measures, patient safety indicators, cost and utilization measures, and practice transformation key performance indicators. Responsible for driving and/or supporting Lean improvement efforts to realize efficiencies and maximized resource utilization.  Responsible for partnering with key stakeholders to define and implement the quality and transformation strategy for ambulatory offices, including AHN-employed practices and independent practices participating in AHN’s Clinically Integrated Network (CIN).  The Senior Director provides direct oversight of practice support teams including but not limited to Pay-for-Value Practice Specialists and Practice Transformation Specialists.                                

ESSENTIAL RESPONSIBILITIES:

  • Lead and/or facilitate internal quality initiatives to achieve successful outcomes and minimized harm to patients and staff. (15%)
  • Maximize impact of P4V programs CMS, Payor and Public Reporting), including focused efforts on opportunities for improved documentation within the record. (15%)
  • Work collaboratively with Institute/Departments/Centers and Allegheny Clinic and CIN leadership to design and implement best practices and drive highest performance outcomes. (20%)
  • Provide ongoing communication on progress, opportunities for improvement and direction on areas of focus throughout the year to various stakeholders and forums. (10%)
  • Provide ongoing educational support for departments and practices in areas of performance improvement including quality models, lean instruction, analysis, facilitation, Patient-Centered Medical Home, practice redesign principles, etc. (10%)
  • Ensure capture and management of all quality related data; ensure timely reporting and transmission of information; provide useful quality analytics to inform decision making. (5%)
  • Develop and deliver learning collaborative curricula to support practice transformation using evidence-based models such as the Patient-Centered Medical Home, Chronic Care Model, and continuous quality improvement methodologies. Oversee the health coach training program and other practice redesign curricula, as needed. (5%)
  • Provide content expertise regarding relevant certification and recognition programs (e.g. NCQ A PCMH recognition, diabetes recognition, Specialty Medical Home recognition). (5%)
  • Serve as the Quality Director for AHN’s Clinically Integrated Network. Key responsibilities include overseeing quality support teams (AHN and payer resources), defining data-driven strategies to maximize performance on value-based reimbursement within AHN-employed and independent practices. (5%)
  • Collaborate with Highmark enterprise partners and other payer representatives to define and implement strategies to maximize performance on P4V programs and ensure consistency of education and training to practice providers and staff on program requirements. (10%)
  • Provide direct oversight of P4V and practice transformation teams supporting primary care and specialty practices (e.g. Chronic Disease Specialty Centers, Advanced Pain Management Centers). (10%)

QUALIFICATIONS:

Minimum

  • Master’s degree in Nursing, Administration, or related field
  • 5-7 years experience in developing, implementing, and anchoring outcomes in process improvement results
  • 5-7 years experience in practice operations, continuous quality improvement methodology and workflow redesign
  • 1-3 years experience with CMS, Insurer-based pay for value programming

Preferred

  • 5-7 years clinical experience in nursing, pharmacy, PT/OT, or related field
  • 3-5 years experience with Joint Commission and CMS Regulations
  • 3-5 years experience with work in a matrix organization and successfully drive results
  • Lean or Six Sigma certification
  • CPHQ certification

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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