Director of Clinical & Quality Performance

Role and Responsibilities

As a Director of Clinical and Quality Performance, your position in this function is responsible for ensuring the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes.

Some examples of tasks include:

• Facilitates continuum of patients' care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes

• Responsible for ensuring the continuity of care for patients transitioning from one level of care to the next, in the appropriate setting

• Consistently exhibits behavior and communication skills that demonstrate Spectrum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customers

• Maintains effective communication with the health plans, physicians, hospitals, PCPs, Value Based partners, extended care facilities, patients and families

• Demonstrates accountability and ownership of patient population assigned

• Seeks and identifies opportunities for process improvement

• Consistently engages in huddles and interacts with Hospitalists / SNFist, Specialists, and medical directors to discuss care plan changes

• Collaborates with Hospitalists / SNFists to identify high-risk patients with complex medical and psych social needs and those at risk for repeat admissions post discharge complications and refers to the appropriate programs

• Performs care management functions on-site or telephonically as the need arises with Value based partners

• Works in conjunction with the hospitalist/post-acute care team and PCP as care team liaison

• Ensures evaluation is in alignment with site-based goals

• Meets with patients, patients' family and caregivers as needed to manage chronic care conditions

• Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes

• Oversees provisions for discharge from facilities including follow-up appointments, home health, DME, specialty services, etc., in order to maintain continuity of care

• Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families

• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports

Qualifications and Education Requirements

• High school graduate, GED or equivalent experience

• Current RN or LPN state license

• Preferred 2-3 years clinical or case management experience

Preferred Skills

• Ability to work with multiple computer platforms simultaneously

• Proficient computer skills including experience with Microsoft Excel

• Self-starter with attention to detail and working familiarity of tech/EMR system