Clinical Quality Manager

Clinical Quality Manager

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas' largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members : Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more.

The Clinical Quality Manager is responsible for implementation, management and oversight of clinical quality strategy initiatives both internally and across ARC's value-based contracts to improve quality and cost outcomes. Establishes strong collaborative relationships with payer partners to reach mutually defined cost and quality goals. Collaborates with other departments, healthcare systems, health plans and other organizations to develop, support and coordinate functions. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Essential Functions :

• Oversees implementation of clinical and quality strategy of ARC's value-based contracts including collaboration with ARC's operational leads, payers and partners to achieve quality goals
• Manages health plan clinical quality relationships and business operations.
• Serves as clinical liaison with payer partners and ensures deliverables are met. Develops presentations / reports and participates in discussions to facilitate effective JOCs with payers.
• Responsible for recruiting, coaching, motivating, scheduling, evaluating, and training employees.
• Responsible for performance evaluations, disciplinary actions, staff training and development, promoting teamwork and fostering a positive work environment.
• Assumes a leadership role in executing clinical projects including the implementation and management of new quality programs, quality measures, applications and new lines of business including new risk arrangements.
• Leads coordination of performing and submission of ACO, HEDIS and Medicare STARS clinical abstraction and quality attestation process for all value-based health plans.
• Attends Clinical Quality Committee, Pedi Clinical Quality Committee and Nursing Ops (if applicable) meetings regularly and participates on sub-committees as needed.
• Identifies, analyzes and prepares evidence-based and clinically actionable materials for Clinical Quality Committee review and distribution on matters involving patient and employee health.
• Researches clinical quality best practices, provides recommendations, and assists with implementation for all specialties with quality initiatives.
• Develops and implements Population Health / Clinical Quality-specific written policies, protocols and programs, and monitors adherence to system-wide policies / standardizations.
• Participates and directs continued development of ARC provider scorecards and integration into ARC practices.
• Oversees quality metric performance and ensure goals and objectives are met.
• Works with operational management and nursing leadership to develop cooperative processes to assure effective coordination on various quality improvement projects.
• Tracks and monitors quality performance and engages in open and constructive dialogue with teams.
• Defines methods for measuring program success and demonstrating program effectiveness in partnership with Clinical Analytics team.
• Leads ARC Clinical Quality Committee activities, meetings and discussions with and between departments within the organizations.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Interviews prospective employees and communicates with Human Resources throughout the hiring process.

Other Duties and Responsibilities :

Qualifications :

Education and Experience :

Required :

Preferred :

Knowledge, Skills and Abilities :

Certificate / License :

Licensed Registered Nurse in State of Texas preferred. Current AHA approved Basic Life Support (BLS) Healthcare Provider Cardiopulmonary Resuscitation (CPR) course completion card preferred.