Sr. Director of Quality, Government Programs Oversight & Population Health

The Senior Director of Quality is responsible for overseeing and managing the quality of care provided under government programs, including Medicare, Medicaid, and other federally-funded healthcare initiatives, and Commercial lines of business. This role is key in ensuring compliance with federal and state regulations, to ensure that the organization meets or exceeds all required quality metrics and performance standards, while improving patient outcomes and reducing disparities across all lines of business. The Senior Director Quality, will work closely with care delivery and the medical group, overseeing strategic initiatives, coordinating across healthcare teams with a focus on prevention, chronic disease management, and addressing health disparities, while ensuring integration of clinical, operational, and data-driven strategies to enhance the health and wellness of populations served by the organization. 

Essential Responsibilities:

• Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.


• Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.


• Directs data collection and analyses to support quality improvement reporting by: overseeing statistical analysis for quality improvement evaluations, special projects, and other work for multidisciplinary review; defining the standards for integrating multiple utilization data reporting systems to develop and maintain a variety of statistical reports in a format which enables care providers to see variations in practice patterns that are adaptable/customizable to adheres to specified formats; presenting and advising on the application of quality improvement metric reports to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical audiences at the senior and executive management level to ensure continued growth and success at KP; and serving as a technical expert to senior and executive management by interpreting and implementing strategies to improve data collection, reporting, and analysis at the organizational level and advising on integration into business goals/objectives to improve KP capability.


• Directs quality improvement and improvement risk management efforts by: defining the standards for corrective action plan for improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys across the organization; ensuring current and future process improvements are compliant with established internal and external regulation requirements at the regional and federal level; defining the standards for root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches; and defining the standards for escalating high-risk issues and trends.


• Establishes the standards and integration of quality improvement performance metrics development, collection, and utilization at the regional and organizational level by: consulting with senior and executive management in setting the standards for performance metrics, standards, and methods to establish improvement success; consulting with senior stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical, meet multidisciplinary standards, and are in line with KP goals; and monitoring the delivery of measurable results and alignment with strategic objectives by integrating metric utilization into workflows, and providing expertise in the development of project structure, charters, metrics, and work agreements throughout the project lifecycle.


• Oversees the development and standards of KP-wide quality improvement initiatives by: directing the implementation of new technology, methods, and tools to develop stakeholders capabilities for process improvements into practice; serving as the technical advisor to senior management on data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; synthesizing key information, breaking down issues into logical components, and identifying barriers to overcome when creating milestones, detailed workplans, and documentation practices in order to create a clear, and realistic plan for regional level improvement processes; and consulting with regional internal and external stakeholders, to define the strategies for quality improvement processes to have consistent design and application of improvement methodologies, use of technology, and prioritization of quality improvement initiatives.


• Serves as the subject matter expert for quality improvement processes and regulations for regions, internal and external committees, and key stakeholders by: providing consultation on the interpretation, interaction, and implementation of current policies, regulations, and legislation and advises on the current climate and potential changes which may have long term effects on business operations; proactively engaging internal and external committees, projects, and relevant initiatives to implement change and to move QA initiatives forward; maintaining collaborative, results oriented partnerships to ensure current and future compliance and advises on changes to KP policy; defining the standards for educational programs to raise awareness for current and changes in regulation requirement, internal concerns, and system/database usage; and identifying systematic barriers to process improvements issues and weighs practical, technical, and KP capability considerations in addressing issues and advises on policy changes.


• Oversees and empowers continuous learning in stakeholder development through quality performance review processes by: defining the processes and standards for utilization and performance reviews processes at the regional and organizational level by utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; developing the standards for performance areas of improvement at the organizational level and sets the standards for corrective action plans; presenting performance review reports at the organizational to senior and executive management, and advises on the integration of best practices and future performance review needs; and defining current, new, and special curriculum for training and educational programs related to process improvement for quality improvement programs.