Job Summary

The Senior Medical Director II, Quality Improvement and Informatics works collaboratively with the Chief Medical Officer (CMO) and is a key position on the Health Services team. Under the Quality Improvement umbrella are four areas: Healthcare Effectiveness Data and Information Set (HEDIS), Disease Management, Quality Improvement, and Accreditation and Oversight. L.A. Care is seeking a physician with Health Plan quality experience and would also like someone with strategic vision to continue to push design in quality programs. This physician must have a passion to improve quality for vulnerable populations. This position needs to implement strategy for the quality improvement function within the health plan, in collaboration with the administrative and clinical leaders of the organization. The position must track and present results of improvement efforts and ongoing measures of clinical processes. Oversee regulatory readiness, quality measurement, and pay for performance programs and initiatives. Establish improvement activities, including methods to track implementation of action plans following site surveys and critical events reviews. The individual must maintain current competency in quality regulations and standards. The role will lead and be responsible for the planning and implementation of clinical information systems (CIS) used in the organization. The position will assist in developing the vision and plan for the adoption of the new digital solutions and analysis for clinical process improvement. This position reports directly to L.A. Care's Chief Medical Officer. The position may lead Data Governance Committees, Clinical Advisory Groups, and serve as liaison to various departments in bridging best practices with CIS solutions.

Duties

Leads the quality efforts for the organization and promotes and supports an organizational culture of quality improvement and performance.

Responsible for the development, implementation and oversight of quality of care policies/programs and clinical guidelines for members.

Oversees all activities relevant to HEDIS, Centers for Medicare and Medicaid Services (CMS), Covered California performance, National Committee for Quality Assurance (NCQA), and state/federal regulatory bodies, including managing provider performance measurement and reporting.

Forges strong relationships and continuing communication links with other providers, medical directors, Board members and the local community.

Responsible for directing peer review activities including chairing the Peer Review Committee and Credentialing Committee, and managing the Potential Quality Incidents Committee.

Serve as the primary liaison between Information Technology ( I.T.) and clinical committees. Build relationships with network providers to gain support of information technology initiatives. Work in concert with I.T. and departmental quality efforts to design and implement systems supporting patient care, research activities, and quality improvement.

Chair the appropriate clinical information system committee(s). Maintain awareness of existing and emerging technology, regulatory, and market factors and assists in the development of the I.T. strategy and plan.

Lead and facilitate key clinical leadership groups in the creation of required clinical content, protocols, workflows and related system usage policies.

Duties Continued

Create and supervise clinical optimization teams to review and enhance system utilization and configuration to improve the efficiency and outcomes of clinical care. Responsive to users’ needs, including training, to assure widespread acceptance and provider use of the clinical systems.

Develop and implement strategies based on medical informatics trends and best practices. Review medical informatics trends, experiences and approaches, develop technical and application implementation strategies and collaborate in the development of strategic plans for clinical information systems.

Work with senior leadership in deploying standardized evidence-based best practices in medicine and clinical content and ensure adoption of best practices.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 10-12 years of experience in medical management and quality management and 5+ years experience in leading a medium to large complex Clinical Information Services environment.

At least 10 years of supervisory/management experience and operations.

Skills

Required:
Evidence of ability to provide leadership in the medical profession, and an interest and involvement in the affairs of the health care community

Ability to work effectively and collaboratively in a diverse community and workplace through partnering, coaching, and teamwork

Other important qualities include excellent communication skills, negotiation skills, consensus building, analytic ability, planning and implementation skills, excellent interpersonal skills to develop and maintain critical internal and external relationships and motivate staff to achieve goals and objectives

Knowledge of equipment operation related to a variety of computer/peripheral equipment

Networks and their operation and related software applications.

Analytical techniques to diagnose user problems and offer corrective action

Ability to communicate effectively in both oral and written form to a widely diverse audience ranging from unskilled staff to highly trained and experienced professionals.

A strong understanding of systems and applications with the ability to develop and apply system solutions to operational requirements.

Able to work closely with physicians, nurses and other health care providers, translate clinical requirements into technical specifications.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information