Medi-cal Quality and Safety Improvement Consultant

2 weeks ago

Oakland, United States Kaiser Permanente Full time

Remote from any KP location in California only.

**Overview**:
This core position involves coordination of Medi-Cal quality oversight structure and activities in Northern and Southern California. This role brings quality improvement content expertise and works closely with the Medical Director for Medicaid and State programs, the KP National Quality team, and the regional quality teams. This role will partner extensively with leadership of TPMG and SCPMG.

**Job Summary**:
Drives a broad range of administrative, facilitation, and technical support functions in the area of Quality and Safety Improvement to coordinate and develop multiple Quality and Safety programs and initiatives. Leverages advanced knowledge and technical expertise to develop, implement, monitor, and continuously improve multiple Quality and Safety programs and initiatives with high organizational impact. Develops, monitors, and oversees performance indicators and metrics for several improvement projects, collaborates across multiple departments to collect, analyze, and trend data from multiple reporting systems and sources to identify opportunities and create plans to improve quality and safety, decrease risk, and maintain the KP safety culture. Develops and coordinates across workgroups to address priority issues and acts as a resource for issues related to quality and safety. Supports multiple committees that are coordinated or chaired by the department. Oversees and ensures organizations compliance with professional standards, laws and regulations, and internal requirements related to quality and safety.

**Essential Responsibilities**:

- Promotes learning in others by communicating information and providing advice to drive projects forward; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides actionable feedback to others, including upward feedback to leadership; influences, mentors, and coaches team members. Practices self-leadership; creates, evaluates, and responds to the strengths and weaknesses of self and unit or team members. Leads the adaptation to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Fosters open dialogue amongst team members.
- Drives the execution of multiple work streams by identifying member and operational needs; translates business strategy into actionable business requirements; develops and updates new procedures and policies. Gains cross-functional support for objectives and priorities; determines and carries out processes and methodologies; solves highly complex issues; escalates and resolves issues as appropriate; sets standards and measures progress. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; influences the completion of project tasks by others.
- Develops advanced data collection and analyses to support quality improvement reporting by: overseeing statistical analysis for quality improvement evaluations, special projects, and other work for multidisciplinary review; integrating multiple utilization data reporting systems to develop and maintain a variety of statistical reports in a format which enables care providers to see variations in practice patterns that adheres to specified formats by department, facility, and region standardized templates; presenting and interpreting quality improvement metric reports to demonstrate improvements and effectiveness of quality improvement programs to a variety of technical and nontechnical audiences at the senior management level; and serving as a technical expert to senior and executive management by interpreting results into actionable plans and resolving issues related to data analysis and storage and advising on integration into strategic goals.
- Investigates opportunities to improve quality improvement and improvement risk management efforts by: leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys across departments and regions; ensuring process improvements are compliant with established internal and external regulation requirements at the local and state level; consulting with key stakeholders on the interpretation of root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement and evaluate newly internalized processes and programs; and driving escalations of high-risk issues and trends to appropriate entity for resolutions.
- Provides technical advice throughout the lifecycle of quality improvement performance metrics development, collection, and utilization at the facility and regional level by: investigating the integration of

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