Medical Director of Quality

Clinical Quality & Competence

• Participate in QAPI Programs, including audits, peer review, patient satisfaction, protocol development and in-service training.
• Provide reports and data summaries relevant to QAPI activities. Additionally, provide ad-hoc reports on quality metrics, when requested by the executive management team.
• Ensure compliance and provide direction and guidance on clinical quality improvement and management programs, including HRSA, CMS, NCQA, The Joint Commission, and other accreditation organizations.
• Monitor appropriateness of patient care, using evidence-based medicine outcomes and clinical guidelines.
• Prepare, review and audit collected clinical data, using appropriate statistical tools, for accuracy and completeness.
• Develop and recommend policies, procedures, and/or programs and processes to improve or enhance the quality, efficiency, and effectiveness of outcomes.
• Identify and remedy problems while continuously searching for clinical quality and performance improvement of systems and operations.
• Collaborate with the IT Department to develop and implement meaningful systems to monitor, manage, measure, and communicate clinical outcomes to providers, supporting staff and management team members.
• Provide coaching and counseling in clinical quality of care to providers when needed.
• Analyze and document current and future workflows to assure efficiency and high quality while assuring highest quality care delivery.
• Work with health plans to identify gaps in care and work collaboratively to break down barriers to improve care.
• Work with hospitals and health plans to identify patients who had recent ER and hospital visits and bring them in the office to close the gap on transition of care issues.

• Design and implement strategies to outreach to patients, who are high utilizers of the health care systems, to reduce ER visits and hospital admissions and engage them in regular consistent team-based primary care medical home (PCMH) visits.
• Maximize the utility of Nextgen, Azara and other reporting systems to identify gaps in care for chronic disease management and preventative care, to proactively manage patients through centralized outreach or on-site huddle reports.
• Assure all deaths and clinical incidents involving clinical care are reviewed for uncovering opportunities to improve care and process.
• Partner with the Director of Quality on quality management processes being conducted and utilized in strategic planning, quality assurance and performance improvement, and clinical staff performance.
• Assist the Director of Quality with the development of health center-wide QAPI Plan and patient safety programs annually.
• Participate in the data collection, validation, and analysis of UDS submission annually.
• Serve as clinical quality consultant to training department when making decisions on staff workflows and competency assessments.
• Attend meetings and other service training, as established by the Chief Medical Officer.
• Participate in utilization review and management.

Health Center Administration

• Partner with clinical staff to promote efficient patient-centered flow and patient satisfaction.
• Promote attitudes, environments and operational systems directed toward patient satisfaction.
• Build high-function work teams to promote effective health center operations.
• Perform other duties as assigned by the CMO.

Medical Service Management

• Assist CMO in the oversight of medical staff policies, procedures, and health care delivery to assure quality PCMH care. Assist in identifying and participating in the resolution of medical service delivery problems.                                                                       
• Assist in the training and orientation of new clinical staff in organizational policies, procedures, and QAPI processes.
• Assist in the resolution of clinical patient grievances and complaints.
• Assist in advising for the development, maintenance and revision of medical protocols, policies, and procedures, in conjunction with medical, nursing, and administrative staff and in compliance with Sunset Health’s standards.

Customer Relations (Internal & External)

• Be part of a team and cooperate in accomplishing organization’s goals and objectives.
• Maintain privacy of all patient, employee, and volunteer information and access such information only on a need-to-know basis for business purposes.

Organization & Community Interaction

• Participate in organizational committees and task forces.
• Assist with representing the Center to the public and medical community on medical care issues, such as standards of practice, quality of care, and benefit policies.
• Comply with all facility policies and procedures, including but not limited to those addressing HIPAA and Compliance.