Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated.

Position Summary: The Director, Quality PHO is responsible for creating, implementing and maintaining a vision and plan for providing improved quality clinical outcomes to patients in the private practice setting which focuses on patient care delivery, utilization management, and oversees a comprehensive program to improve clinical outcomes, enhance value, in collaboration with the Leadership team.

Essential Duties and Responsibilities:

• Devise strategies and plans for the PHO according to company standards for quality, excellent service, financial growth and operational excellence.
• Manage client relationships and product delivery for multiple high-profile, multi-product clients while supporting the internal clinical team, comprised of private office staff, clinical operations, and product expertise in data/analytics
• Subject matter expert regarding the HEDIS product line
• Represent the Clinical Integration product for both client and internal business process meetings
• Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service
• The position works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees
• Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO
• Acts as a role model for clinical staff, promoting education, development and adoption of practice transformation with focus on Quality Improvement, clinical workflow, member satisfaction, improved RAF scoring
• Promotes collaboration while working closely with Administrative Director Value Based Care, in conjunction with maintaining appropriate communication with CMO and Senior Leadership
• Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office     setting
• Responsible for oversight of clinical training activities and outcomes.
• Help develop, lead, and implement Utilization Management plan that will help PHO achieve incentive goals set forth by insurance plans.
• Continually assesses all patient care related services, identifies problems and opportunities, and utilizes data to analyze and propose innovative approaches for solutions.
• Oversee all aspects of the quality program including quality measurement, external reporting, quality improvement, regulatory/accreditation compliance, and high reliability
• Position will be hybrid with onsite presence being necessary when requested

Required Qualifications: 

Education and Training:

• Bachelor’s degree in nursing or related health care field required.
• Licensed Registered Nurse preferred.
• 10 years management experience as well as 5 years' experience in ambulatory healthcare setting with focus on quality care gap closure and clinical education.

Work Shift Details:

Days, Monday through Friday
Hybrid

Department:

AFFILIATE ADMIN

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.   

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

·       Medical, Dental and Vision plans

·       Life Insurance

·       Flexible Spending Account

·       Other voluntary benefit plans

·       PTO and Sick time