Quality Improvement Clinical Manager / Job Req 1023712205

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPAL RESPONSIBILITIES: The Quality Improvement Clinical Manager is responsible for overseeing clinical safety activities to ensure compliance with regulatory requirements and the continuous improvement of quality of care and services.

This role requires collaboration with various departments to address quality concerns, implement corrective action plans, monitor the effectiveness of interventions, and process improvements for efficiency and effectiveness of operational processes.

Clinical safety activities pertaining to the Quality Improvement Health Equity (QIHE) Program includes Facility Site Review (FSR), Grievance & Appeals (G&A), Potential Quality Issues (PQI), Provider Preventable Conditions (PPC), quality of care corrective action plans, and clinical activities to improve the quality of care/service for members.

Principal responsibilities include: Oversee operational and tactical strategies for clinical safety activities to promote detection, prevention, and remediation.

Lead cross-functional meetings to address system trends based on monitoring issues, findings, or analysis of clinical safety activities and other data points Develop and implement process improvements or workflows relating to FSR, PQI, PPC, G&A or other related clinical quality activities that improve efficiency or effectiveness Collaborates with other departments (i.e.

Provider Services, Compliance, etc.) for cases requiring escalation and/or address barriers to ensure timely closure of corrective action plans Manages the Skilled Nursing Facility/Long Term Care (LTC) quality monitoring program in collaboration with the LTC to ensure safe care for members Manages ad hoc chart reviews to assess, address, or monitor quality of care issues, trends, regulatory audit findings, or strategic priorities Contributes toward clinical key performance indicators at Joint Operating Meetings Conducts cross-functional root cause analysis and action plans to address quality of care issues Develops inter-rater reliability and quality assurance processes to ensure accuracy, appropriateness, and competency to process PQIs and Grievance and Appeals cases Develops, updates, and maintains policies and procedures, standard operating procedures, and other operational documents pertaining to the clinical safety unit Contributes to the Quality Improvement Health Equity (QIHE) Program trilogy documents (evaluation, program description, and workplans) and related documentation Facilitate clinical quality oversight through periodic reviews, chart audits, and reporting of key performance indicators.

Addresses complex quality of care problems and facilitate an integrated approach to improvement initiatives Develops a comprehensive approach to achieving internal and external standards for quality and clinical safety.

Develops and maintain dashboards for providers with defined expected outcomes & benchmarks based ...