American Health Network Clinical Quality Manager in Indianapolis, Indiana

American Health Network, a growing care delivery organization within United Health Group, is a national leader in delivering high-quality, convenient, affordable healthcare in a patient centric manner. We are uniquely positioned to address two of the largest challenges facing the U.S. healthcare system – access and affordability.

Job Summary

Reporting to the Vice President of Clinic Operations, the Manager of Clinical Quality will direct, administer, track and control the day-to-day oversight of clinical compliance, patient safety, infection control & prevention (clinical compliance, infection control & prevention will be referred to as Clinical Quality the remainder of this document) to ensure the health and safety of our patients and employees. Additional responsibilities will include coordinating with practice leadership within the markets to ensure compliance with State and Federal health plan requirements, Medicare Guidelines, National Organizations (e.g., OSHA, NCQA, etc.), UHG, Optum, and AHN Physicians established policies and procedures. The position will provide strategic and management input for clinical operations related to Clinical Quality programs.

Essential Job Functions

  • Establishes and maintains a self-assessment program within the practices/markets to assess compliance with applicable Clinical Quality procedures and policies.

  • Maintains up-to-date working knowledge of national standards and guidelines related to Clinical Quality programs and occupational health and safety.

  • Promotes understanding, communication and coordination of Clinical Quality/compliance initiatives and standards.

  • Provides recommended approaches and collaborates effectively with all functions that impact Clinical Operations to include Occupational Health and Safety as well as other corporate departments to investigate and develop preventive and corrective action plans based on early and timely escalation of potential non-compliance issues.

  • Develops, manages, and adjusts the clinical compliance assessment plan and schedules, based upon current business needs.

  • Reviews and manages multiple quality activities and reports of varying complexities.

  • Reports findings (at various levels of detail) to stakeholders and management, including recommendations based upon findings.

  • Provides quality metrics to management on a routine basis. Actively participates in meetings as assigned.

  • Maintains a system for tracking and trending standard operating procedure deviations; develops training plan with Clinical Education and Training to correct deficiencies.

  • Serves as a Clinic Operations subject matter expert for Clinical Quality and compliance.

  • Provides consultative support to Clinical Operations for internal and external regulatory and quality audits.

  • Tracks and ensures closure of all Clinic Operations quality related corrective action plans in conjunction with the Corporate Compliance Officer.

  • Provides pre-inspection/assessment preparedness activities for regulatory, UHG/Optum, and corporate as related to clinic audits.

  • Builds/maintains good working relationships with functional areas that support Clinic Practice Operations.

  • Assists in the development and implementation of new clinic business operation.

  • Communicates and educates internal partners and providers on Clinical Quality Compliance.

  • Partners with legal counsel and compliancevofficervto stayvabreast ovflatest regulatory requirements.

  • Monitors Occupational Health Programs and notifies employees when actions are due (e.g., TB Screening, Hep B Screening, N-95 Fit Testing, Flu Immunization, etc.).

  • Coordinates and schedules required training for occupational health and safety programs

  • Oversees, manages and implements the development, planning, and execution of continual process improvement efforts, policies and procedures,and regulatory compliance functions related to practice operation programs and occupational health services activities.

Minimum Required Education, Experience & Skills

  • Bachelor’s Degree in Nursing or a related field required.

  • Registered Nurse with active state licensure

  • Eight or more years of health delivery or service operations experience, including five years of progressively responsible management experience.

  • Excellent communication skills with management, physicians, patients and staff required.

  • Knowledge of Federal and State laws and Joint Commission/NCQA regulations relating to clinic operations.

  • Knowledge of occupational health programs such as monitoring TB screening, Hep B screening, N-95 Fit Testing, etc.

  • Willing to travel as deemed necessary.

Preferred Education, Experience & Skills

Experience in Infection Control and/or clinical Compliance programs. (Joint Commission, NCQA, etc.)