1+ months

Director Clinical Programs *$25,000 Hiring Bonus*

Providence Health & Services
Torrance, CA 90509
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**Description:**
**Providence is calling a Director Clinical Programs (Full time/Day shift) to Providence California Regional Services in Torrance, CA.**
**Apply today! Applicants that meet qualifications will receive a text with additional questions from our MODERN HIRE screening and interview system.**
**_Please upload a current resume reflecting all relevant experience_**
**This position is eligible for a $25,000 Sign-On Bonus for external candidates**
**We are seeking a Director Clinical Programs** who will lead Quality and Utilization Management, and oversight of delegated Credentialing activities for Providence Health Network. Providence Health Network has quality programs for the commercial, marketplace, Medicare, and Medicaid lines of business. The Director is responsible for organizing Providence Health Networks quality and utilization management, and credentialing governance committees and the development/maintenance of policies and procedures required to maintain compliance with regulatory and accrediting bodies, including routine evaluations of enterprise programs and services.
**In this position you will:**
+ PROGRAM ACCOUNTABILITIES:
+ Lead the quality and utilization management programs for PHN, all LOBs. This includes unique relationships held whereby quality and utilization is a delegated function from PHN to other delegated entities
+ Assure that policies and operating procedures are comprehensive, implemented and reviewed annually
+ Analyze and interpret data, assessing impact on care or service. Develop potential interventions and cost/benefit of such interventions. Prepare and present periodic reports on specific areas of health services utilization as directed. Report performance, both activity volume and outcome, on a monthly and year-to-date basis, assessing for improvement opportunities
+ Prepare and present evidence of quality and utilization compliance for payer and regulatory audits and accreditation surveys
+ Evaluate components of Clinical Programs Management; i.e. utilization management and quality management as appropriate to area of responsibility at least annually and assess for improvement opportunities
+ Assist in external contracting for delegated services for PHN
+ Research potential quality of care issues, assessing for system problems as well as individual, case specific issues
+ Responsible for oversight of delegated quality programs
+ Assist in the development, implementation, and maintenance of the provider reporting, which incorporates utilization, quality, and credentialing data. Collaborate with the credentialing and quality committees to ensure that provider performance monitoring is effectively handled
+ Oversee the quality of care complaint handling process ensuring that it is timely and compliant with external requirements
+ Develop action plans for health plan quality measurement programs, such as CMS 5 Star, NCQA commercial ratings, Marketplace Quality Rating System, and Health Share incentive measures
+ DEPARTMENT MANAGEMENT AND HUMAN RESOURCES FUNCTIONS:
+ Management of staff, which includes goal setting, hiring and terminating, training, performance evaluations, the development of corrective action plans, and monitoring for improvement
+ Identify training needs and provide for the development and continuing education of professional staff to ensure competency
+ Act as a mentor and provide consultation to staff in quality and utilization management
+ ACCREDITATION AND REGULATORY REQUIREMENTS:
+ Assure that applicable regulatory and accrediting requirements are met in a timely and professional manner. Prepare fully for all regulatory and accrediting agency audits and reviews
+ Develop and monitor corrective action plans and project action plans, reporting to management and committees as appropriate
+ Identify and implement tools that assure compliance with DMHC, CMS,, NCQA and other regulatory and accrediting agencies
**Qualifications:**
**Required qualifications:**
+ Bachelor's Degree in Nursing or other clinical field
+ Master's Degree in Public Health, Healthcare Administration, Business Administration or other relevant healthcare program or 4 years equivalent healthcare quality experience
+ Minimum 7 years Management experience including 7 years supervisory or leadership experience
+ Demonstrated experience working well with physicians
+ Demonstrated successful project management and program development
+ Demonstrated experience in program planning, development and evaluation
+ Quality and Utilization Management Improvement Program Development experience
+ Strong organizational skills
+ Comfortable with data. Ability to analyze data sets, draw conclusions, understand significance
+ Strong problem solving skills. Creative and flexible approach to program development and implementation
+ Excellent communication skills, both written and oral
+ Ability to present to small and large audiences
+ Ability to communicate effectively with physicians
+ Demonstrated knowledge of confidentiality and peer review protection principles
+ Demonstrated working knowledge of health care value concepts and managed care principles
+ Skill in identification of internal and external customers, determining customer needs and responding to those
+ Ability to conduct oneself in a professional manner, both orally and in writing, and to develop harmonious and enthusiastic working relationships with supervisors, associates and other organizations as well as the general public
+ Knowledge of regulatory and accrediting body requirements, specifically, CMS, NCQA and DMHC
+ Ability to motivate and lead both departmental staff and non-reporting multi-disciplinary staff
+ Ability to influence change in provider groups. This includes working with providers and other key leaders of provider group
+ Can effectively collaborate with other external stakeholders including payers
+ Results driven
+ Ability to work in details. Is self directed to learn key areas of knowledge gaps
+ Able to work strategically, at a higher leve
+ Knowledge of basic physician billing/coding practices, and clinic workflows beneficial
+ Demonstrated working knowledge of Risk management as related to medical management decision
+ Ability to work well with physicians
+ Strong data focus with basic analytic skills
+ Highly functional in Excel
**Preferred qualifications:**
+ Certification in quality preferred (CPHQ) - Certified Professional in HealthCare Quality
+ Experience in quality management principles, tools and techniques, such as: six sigma, Root cause analysis, PDSA, lean
**About the ministry you will serve:**
Anchored by five award-winning comprehensive medical centers, Providence provides a full spectrum of care that includes a range of specialties, signature services, outpatient and home care and the well-regarded Providence Medical Institute, a group of physicians and primary and urgent care clinics throughout the greater San Fernando Valley and South Bay. Providence is focused on providing the communities it serves with preventive care, education and leading-edge diagnostics and treatment. The organization includes numerous outreach programs. hospice and home care and even our own Providence High School, a Blue Ribbon college-preparatory campus.
**We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit**
https://www.providenceiscalling.jobs/rewards-benefits/
**Our Mission**
As expressions of Gods healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
**About Us**
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
**Schedule:** Full-time
**Shift:** Day
**Job Category:** Non-Clinical Lead/Supervisor/Manager
**Location:** California-Torrance
**Req ID:** 304951
Posted: 2021-07-29 Expires: 2021-12-16
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Director Clinical Programs *$25,000 Hiring Bonus*

Providence Health & Services
Torrance, CA 90509

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