Director, Clinical Quality

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

The Director, Clinical Quality is a pivotal role, spearheading continuous clinical quality improvement initiatives and managing high-priority quality improvement projects, encompassing primary and specialty care and integration. Utilizing the DMAIC (Define, Measure, Analyze, Improve, Control) process, this role will work cross-functionally to enhance patient outcomes, streamline processes, and foster a culture of clinical excellence in member care. The role also involves driving the development and implementation of clinical performance metrics, ensuring effective quality measurement, data analysis, and the execution of actionable improvement strategies to enhance clinical outcomes and operational efficiency. Additionally, the Director, Clinical Quality will support a portfolio of performance initiatives to achieve strategic and financial goals.

Key Responsibilities:

Innovation:
Develops common set of core quality metrics for core sub-specialties that align with national measure to improve patient outcomes and minimize provider complexity.
o    Oncology
o    Cardiology
o    MSK
o    Radiology

Stakeholder Collaboration: 
o    Serve as a liaison between clinical teams, analytics, partner operations, strategic accounts, and leadership to ensure alignment on quality improvement priorities and goals.
o    Synthesize and present findings to leadership and develop visually appealing content that effectively communicates findings and recommendations.
o    Facilitate regular communication and updates on metric development, trends, and improvement initiatives.
o    Engage cross-department leaders and stakeholders to design and execute initiatives across clients/markets.

Documentation and Communication:
o    Create clear, accessible, and actionable documentation for clinical performance metrics.
o    Communicate progress and results of quality initiatives to stakeholders, including executive leadership and clinical teams.

Quality Data Analysis and Insights:
o    Analyze quality data to identify trends, variations, and opportunities for improvement.
o    Interpret findings and collaborate with stakeholders to understand root causes and potential impacts.
o    Use available data to determine whether implemented initiatives achieve metrics of success, working cross-functionally to refine approach as needed.

Quality Improvement Initiatives:
o    Develop and implement action plans based on data-driven insights to address identified trends and gaps in performance.
o    Partner with clinical, operational, and analytics teams to monitor the impact of improvement efforts and refine strategies as needed.
o    Define & Understand Scope: Establish clear project objectives and goals in alignment with organizational priorities. Collaborate with Medical Directors and analytics teams to identify key clinical performance metrics.
o    Measure and Analyze: Collect data to measure current process performance and establish baselines. Analyze quality data to identify trends, variations, and improvement opportunities. Understand root causes and impacts.
o    Improve and Control: Implement evidence-based interventions to enhance quality and reduce variability. Monitor key performance indicators to sustain improvements and make necessary adjustments.

Performance Management:
o    Manage high-priority performance initiatives through all phases of design and execution, including post-go-live tracking, to realize strategic and financial goals.
o    Maintain a catalog of performance initiatives, including their description, high-level sizing, and other key criteria for prioritization.
o    Develop and maintain project management processes, tools, and templates for performance initiatives.
o    Ensure strict compliance with federal and state regulations and company policies, procedures, and processes.

Qualifications (Required and