The Sr. Medical Director of Quality is a physician executive responsible for advancing clinical quality, patient safety, and population health outcomes across the organization. This role is focused on driving strategic initiatives related to HEDIS and STARS performance primarily, and over time is anticipated to include the area of HCC risk adjustment as well. The Sr. Medical Director of Quality collaborates with leadership, clinicians, and care teams to ensure the delivery of quality care to the patients we serve, i.e. care that is safe, effective, patient-centered, timely, efficient, and equitable. Given we operate in a value-based care environment, it is imperative that the Sr. Medical Director of Quality be capable of understanding and driving improvement of both the quality and cost components of high-value care. The Sr. Medical Director of Quality will be supported by and oversee a team of individuals focused on quality improvement work across the organization. Success for the Sr. Medical Director of Quality will be primarily measured through achievement of CMS Star, HEDIS and HCC-RAF goals for the company.
Key Responsibilities:
Strategic Quality Leadership:
- Develop and lead the organization's clinical quality and patient safety strategy in alignment with federal and payer-based value programs.
- Guide performance improvement initiatives that impact HEDIS, STARS ratings, HCC coding accuracy and risk adjustment scores.
- Collaborate with executives within and external to the organization to implement quality priorities and monitor impact.
Clinical Quality Programs:
- Oversee measurement, reporting, and performance improvement efforts related to: HEDIS (Healthcare Effectiveness Data and Information Set),CMS STARS (Medicare Advantage Star Ratings Program),HCC (Hierarchical Condition Categories for risk adjustment) to be incorporated as an area of oversight over time.
- Direct clinical quality initiatives aimed at improving preventive care, chronic disease management, and patient experience.
- Serve as the clinical champion for population health and value-based care transformation.
Patient Safety & High Reliability
- Lead the organization's efforts to reduce preventable harm, adverse events, and readmissions.
- Cultivate a culture of safety and continuous learning using tools like root cause analysis, incident reporting, and just culture frameworks.
- Regulatory & Accreditation Readiness
- Collaborate with colleagues within and external to our organization to ensure compliance with regulatory and accreditation standards
Successful candidates will embody a sense of accountability and ownership of quality improvement efforts in our organization, work collaboratively with others, espouse a continuous-improvement mindset, and be able to break down barriers, be detail-oriented, tactical, and have strong communication skills.
Education/Experience:
- Doctor of Medicine ( MD) degree
- Board certification in the relevant specialty
- Active medical license in California
- Strong organizational skills - Detail-oriented and tactical approach
- Excellent written and verbal communication skills
- Proficiency in Microsoft Excel, Word, and Access
- Successful candidates will demonstrate accountability and ownership in quality improvement initiatives within our organization. They should work collaboratively with others, embrace a mindset of continuous improvement, and effectively address and overcome barriers.
Compensation will be dependent on experience and is expected to include a base of $250k-$400k annually, bonus potential, and relocation assistance offered if necessary. The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life. Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
- Employer-paid comprehensive medical, pharmacy, and dental for employee
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)
- Behavioral Health Services
- Savings and Retirement:
- 401k Retirement
- Savings Plan
- Income Protection
- Insurance
Other Benefits:
- Vacation Time
- Company celebrations
- Employee Referral Bonus
- Tuition Reimbursement
- License Renewal CEU Cost Reimbursement Program
- Business-casual working environment
- Sick days
- Paid holidays
- Mileage
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.