Chief Quality Officer

• Ensures consistent and continual monitoring of quality of care delivered. Develops and oversees a communication strategy to the physicians regarding measures and current performance to include supportive process improvement guidance.
• Establishes, implements, and supports programs, procedures, and policies to accomplish organizational quality objectives including Patient-Centered Medical Home (PCMH), Meaningful Use (MU), Physician Quality Reporting System (PQRS), and dashboard quality measurement programs.
• Promotes quality improvement initiatives targeting patient satisfaction as well as timely, appropriate, and accessible healthcare.
• Oversee medical group peer review, credentialing and risk management

• Supports comprehensive care management in protocol creation, communication strategy, and engagement of physicians
• Leads strategies related to care coordination, complex patient management and transitions of care
• Partners with Physician Lead for Supportive Care / Complex Care and Palliative Care to oversee MMG’s special focus groups: Hospital at Home, Palliative Care, Home Care, Medicare Advantage, ED Diversions and Pharmaco-economics.
• Promotes the role CQO to the public, health care organizations, professional associations, and purchasers of healthcare services.
• Develops cooperative relationships with external physicians, hospitals, community organizations and other healthcare facilities to collaborate and exchange information

• Assists in setting strategy and leading initiatives to improve value-based care performance measures, shared savings opportunities, and contract measures through partnership with foundation, hospital and regional leadership.
• Promotes adoption of new payment models in primary care and specialty practices driving improved quality of care, healthcare affordability and financial sustainability for MMG and Dignity Health.
• Provides reports to internal and external stakeholders on the progress and success of the organization as it pertains to the quality, cost of care, and clinical integration for the patients served.
• Ensures full awareness and alignment with Dignity leadership regarding overall performance on value-based contract arrangements as well as any challenges, successes, or needs.

Utilization Management

• Helps ensure that the complex capitated patients are receiving the enhanced care required to help drive to most appropriate utilization.
• Provides medical support and decision-making for medical services activities to ensure a sound medical basis for appropriate cost-containment and quality of care decisions.
• Reviews problem claims with the Medical Claims Reviewer and makes decisions on medical-related claims payment disputes.
• Develops processes for review on all medical appeals initiated by members or providers to ensure sound medical rationale for grievance decisions.
• Promotes best practices and decreased variability across the care continuum to drive high-value care.
• Oversees all UM efforts in partnership with Dignity Health Medical Foundation (DHMF) Care Coordination and UM as well as Dignity Hospital UM leadership.
• Develops cooperative relationships with MMG and external physicians to collaborate and provide high-value care.
• Directly responsible for UM team structure. Ensures high quality work is completed effectively and efficiently by UM direct reports, including:
  • Associate Medical Director for Surgical UM
  • Associate Medical Director for Post-Acute Care UM
  • Associate Medical Directors for Hospital UM
  • Associate Medical Directors for Ambulatory UM

Data Reporting / Committees & Meetings

• Provides reports to internal and external stakeholders on the progress and success of the organization as it pertains to the UM, cost of care, out-of-network and clinical integration for the patients served.
• Ensures full awareness and alignment with Dignity leadership regarding overall UM performance as well as any challenges, successes, or needs.
• Reviews medical and pharmacy utilization/claims reports monthly and identifies and solves cost-containment/quality of care problems.
• Problem-solves to change negative utilization trends, including unnecessary out-of-group

• Integrates Value-based Care initiatives with the operational quality improvement, UM, and population health committees of the MMG, Dignity Health service lines, and the Clinical Leadership Council.
• Promotes relationship building with key employer groups, physician groups, individual physicians, managed care organizations, insurance plans and state medical associations and societies.
• Drives quality and compliance to ensure that care meets and exceeds medical management, regulatory, agency, and quality standards.
• Leads the Utilization Management team to develop processes that improve care and minimize costs.
• Supports state regulatory relationships and may serve as the lead physician for state and federal medical management regulatory audits.
• Leads relationships with Hospital and DHMF partners for MMG provider credentialing and Peer Review efforts.

• Previous experience in Social Determinants of Health initiatives.
• Experience and success in leading and facilitating groups of physicians in quality improvement projects.
• Experience and knowledge in use of administrative data, quality data specifications, and statistical validity.

• Able to influence peers through effective communication skills.
• Comfortable articulating the vision of MMG to provide high value care to patients (excellent quality and patient experience in a cost efficient manner)
• Commitment to obtain management training through MMG or elsewhere.
• A commitment to fulfill the duties of the office.
• Foster an environment of diversity, equity, inclusion and belonging.
• Possess initiative, good judgment, discretion, and decision-making skills.
• Willingness to “roll up the sleeves” to get the job done