Director of Quality

APLA Health
Published
November 23, 2020
Location
Los Angeles, CA
Category
Job Type

Description

APLA Health’s mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities and people living with and affected by HIV. We are a nonprofit, federally qualified health center serving more than 14,000 people annually. We provide 20 different services from 15 locations throughout Los Angeles County, including: medical, dental, and behavioral health care; PrEP counseling and management; health education and HIV prevention; and STD screening and treatment. For people living with HIV, we offer housing support; benefits counseling; home health care; and the Vance North Necessities of Life Program food pantries; among several other critically needed services. Additionally, we are leaders in advocating for policy and legislation that positively impacts the LGBT and HIV communities, provide capacity-building assistance to health departments across the country, and conduct community-based research on issues affecting the communities we serve. For more information, please visit us at aplahealth.org.

APLA Health is currently seeking a Director of Quality  to join our Baldwin Hills team! We offer great benefits, competitive pay, and great working environment!  

We offer:

• Medical Insurance

• Dental Insurance (no cost for employee)

• Vision Insurance (no cost for employee)

• Long Term Disability

• Group Term Life and AD&D Insurance

• Employee Assistance Program

• Flexible Spending Accounts

• 10 Paid Holidays

• 3 Personal Days

• 10 Vacation Days

• 12 Sick Days

• Metro reimbursement or free parking

• Employer Matched 403b Retirement Plan

This is a great opportunity to make a difference!

Director of Quality (90016)

POSITION SUMMARY:

APLA Health & Wellness (APLAHW) is seeking a qualified individual to provide leadership and expertise to ensure the delivery of safe, high quality patient care and client services at all sites. This individual would be a member of the APLAHW senior management team.  APLAHW provides culturally competent medical, dental and behavioral health services to predominanty low-income individuals in Los Angeles County, with a specific focus on the LGBT community.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

• Supervise the quality department, including 3 managers: one each for quality, risk/compliance and utilization.  Each manager supervises multiple staff.

• Hires or supervises hiring additional Quality Improvement, Risk/Compliance and Utilization staff depending on the needs of the organization.  

• Represents APLA Health as the Senior Quality, Compliance/Risk, Utilization Management  staff to various community associations and external agencies, including CCALAC, CPCA, HRSA and others as appropriate.

• Oversees a corporate wide quality improvement program inclusive of all staff, maintains a written quality improvement plan and annual evaluation of the plan’s effectiveness. 

• In collaboration with the Medical Director, develops and maintains a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and reporting of established quality measures related to key operational and clinical processes and outcomes. 

• Develops and maintains policies and procedures related to quality management.

• Under the medical director, facilitates the monthly Quality, Compliance, Risk and Utilization Management meeting.

• Provides guidance on maintenance of APLAHW’ status as a patient-centered medical home per National Committee for Quality Assurance (NCQA) standards.

• In collaboration with the medical director and nursing director, oversees population health management plans.

• Oversees electronic storage of quality improvement reports to promote ongoing access for key stakeholders. 

• In coordination with the medical director and COO, oversees a corporate compliance program, develops and maintains a written corporate compliance plan and annual evaluation of the plan’s effectiveness; ensures that all required elements of a compliance program are addressed. 

• Develops and maintains policies and procedures related to the corporate compliance program.

• In consultation with the Medical Director and CEO, submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies. 

• Oversees a corporate wide risk management program, develops and maintains a written corporate risk management plan and annual evaluation of the plans’ effectiveness. 

• Develops and maintains policies and protocols supporting the risk management plan.

• Oversees, and develops as needed, processes for internal incident reporting, as well as external complaint and grievance management.  Investigates and evaluates claims and potential claims. 

• Oversees a clinic wide patient safety program, develops and maintains a written patient safety plan and annual evaluation of the plan’s effectiveness and develops and maintains policies and procedures related to the patient safety program. 

• Collaborates with the Medical Director in the investigation of clinical events including sentinel events, sentinel event near misses, and significant adverse events; leads and/or participates in the development of root cause analyses as directed by the Medical Director. 

• Develops plans for and ensures all employees participate in training that will create greater awareness and meet all compliance requirements.

• Acts as Privacy Officer for the clinics.

• Oversees the process of achieving and maintaining FTCA coverage.

• Oversees the emergency management plans for each clinic site as well as the agency as a whole. 

• Oversees the development, execution, and evaluation of an agency utilization management plan and efforts.  

• Oversees the Utilization Review Program at APLA Health

• Works closely with outside agencies, such as the IPAs (Independent Provider Associations), to promote cost-effective care.

• Oversee efforts to ensure that documentation captured accurately reflects services performed and complexity of care in order to maximize health plan and IPA reimbursements.

• Coordinates with the billing department to help achieve payment maximization for services rendered

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

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