The regulatory function is vital in making safe and effective healthcare products available worldwide. Individuals who ensure regulatory compliance and prepare submissions, as well as those whose main job function is clinical affairs or quality assurance are all considered regulatory professionals.
One of our most valuable contributions to the profession is the Regulatory Code of Ethics. The Code of Ethics provides regulatory professionals with core values that hold them to the highest standards of professional conduct.
Like all professions, regulatory is based on a shared set of competencies. The Regulatory Competency Framework describes the essential elements of what is required of regulatory professionals at four major career and professional levels.
Join the brightest minds in regulatory at the annual Regulatory Convergence. See the global regulatory community in action. Intensive workshops. Topical sessions. Meet ups with regulators. This is where it all comes together.
Leads the development and operation of systems and processes to collect and collate quality metric performance.
Leads the process to identify and prioritize potential clinical quality, cost, and utilization opportunities that may affect clinical or financial performance of value-based contracts.
Leads the CQCI team in the development of strategies to evaluate selected opportunities.
Leads the process in collaboration with various stakeholders to formulate recommendations for improvement based on the completed analysis.
Oversees the preparation of graphs and reports to present findings and recommendations.
Collaborates with PHSO, Advent Health and CIN leadership and teams to assist in the implementation of accepted recommendations.
Leads the design, implementation, and operation of assigned systemic quality and cost improvement activities.
Leads the development and deployment of appropriate control measures to track improvements and ensure continuous improvement in performance.
Participates in ongoing Performance Review Committee meetings as requested.
Oversees the surveillance of clinical innovation vendors and opportunities. Tracks these opportunities and informs senior leaders as appropriate of their availability and potential.
In collaboration with PHSO leadership and teams develops business plans for clinical vendor relationships.
Leads the implementation and management of selected quality, cost and / or utilization initiatives. Manages vendor contracts and relationships. Ensures the initiatives achieve the desired performance.
Responsible for the daily activities and operations of the CQCI team, including but not limited to oversight of each of the clinical care initiatives and addressing staff related issues/concerns.
Responsible for hiring, training, evaluating and all other human resources functions for the CQCI staff that report to this role.
Responsible for the development and maintenance of policies and procedures as needed to support the CQCI function or regulatory requirements.
Prepares and manages departmental budgets.
Builds strong relationships with leadership, customers, and peers. Communicates appropriately and effectively with all stakeholders, customers, and supervisors maintaining awareness of any issues, potential delays, and any situation of concern that may affect the timeliness of process implementation.
Responsible for exceptional customer service by promoting an image of a professional high-quality organization through expertise and responsiveness.
Prepares reports, attends meetings, and presents information as requested.
Performs other duties as needed to support ongoing operations.
What You Will Need:
Education and Experience Required:
Bachelor’s degree in nursing or another health-related field, public health / epidemiology, statistics, engineering, health administration, or business or related field.
7+ years of experience in healthcare.
5+ years of management experience.
5 years of experience in managed care or population health.
2+ years of experience leading a team responsible for healthcare analytics.
Knowledge and Skills Required:
Excellent knowledge of health plan operations, managed care principles and practices, network management, and clinically integrated networks.
Excellent knowledge of analytical methods and tools to evaluate clinical quality, utilization, and cost trends for value-based contracts.
Substantial knowledge of advanced performance improvement methodologies including lean six sigma and change management.
Excellent verbal and written communication skills with the ability to communicate clearly, coordinate and work effectively with teams, and tailor messages to individuals and audiences throughout the institution with differing knowledge levels.
High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, physicians
Excellent problem solving, prioritization and operational skills with the ability to make independent decisions and resolve problems.
Strong organizational and management skills.
Ability to manage multiple initiatives to achieve organizational goals.
Proficient using desktop applications and database programs, particularly Microsoft Office (Word, Excel, PowerPoint, and Outlook
The Executive Director – Clinical Quality and Cost Innovation (CQCI) for the Population Health Services Organization (PHSO), the value-based insurance division of AdventHealth, leads the interdisciplinary Clinical Quality and Cost Innovation (CQCI) team related to population health for the system. This position is responsible for a portfolio of risk with over $2 billion in covered expenses and 425,000 lives across a multistate health system that includes multiple clinical integration networks (CINs) and accountable care organizations (ACOs). The position and team continuously collaborate with various PHSO departments, the PHSO CINs and ACOs, Advent Health Clinical, Advent Health Medical Group, and various payer / partners to carry out four major functions.
Clinical quality and cost analysis – The team performs detailed research and analysis to identify clinical quality, cost and utilization improvement opportunities within the value-based contracts held by the Advent Health PHSO and its affiliated ACOs and CINs. Based on this analysis, the team will develop detailed recommendations for improvement.
Quality Measurement and Reporting – The team will measure and report on clinical quality metrics. The scope includes standard CMS and other accreditation or payer metrics as well as metrics developed within the PHSO.
Clinical Improvement Strategies – The team will collaborate with the PHSO ACOs and CINs on the implementation and maintenance of accepted quality, cost, and utilization recommendations. Additionally, the team will develop, implement, and manage systemic improvement activities when appropriate.
Clinical Innovation Programs – The team is responsible for market surveillance of clinical innovation opportunities, as well as the development, implementation and maintenance of programs assigned to the PHSO that are designed to improve clinical quality, utilization and cost, and member and physician satisfaction. This includes the management of vendor contracts and relationships.
Through these efforts, the PHSO will improve the health and wellness of individual program participants; improve the overall health of value-based populations; and influence the appropriateness of utilization and costs for PHSO healthcare services. The team will work with various stakeholders to improve processes and transform the practice of medicine to reduce variation in how care is designed, provided, and delivered to optimize value-based performance.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.