Honor Community Health is a 501c Federally Qualified Health Center. Our mission is to provide for the health and wellness needs of the underserved of Oakland County through the provision of comprehensive, integrated primary, behavioral health, and dental care. We see all populations regardless of their ability to pay. Honor Community Health is a rapidly growing organization co-located within 20 locations. Our team is passionate about serving the people of Oakland County. *NOTE: All employees are required to receive the COVID-19 Vaccine.

Position Description

The full-time Manager, Clinical Quality is responsible for oversight of the organization quality measures and adherence, assisting in quality improvement activities that ensure Honor Community Health’s consistent performance of best practice, leading to a high level of patient satisfaction, effective, efficient safe and high-quality care that maintains compliance with regulatory requirements and accreditation standards.

This position reports to the Chief Operating Officer. Our standard hours are Monday- Friday, 8:30am-5:00pm.

Responsibilities:

1. Quality Assurance and Improvement Expertise
2. Performs other duties as assigned.
3. Serves as a resource for the Chief Operating Officer, Associate CMO, and Chief Medical Officer for all external and internal quality audits.
   1. Ensures that corrective action plans are documented in a timely manner and effectively implemented.
4. On a monthly basis, complete chart audits for providers as requested by the Associate CMO to identify documentation errors within the EHR and provide training to these providers to improve compliance.
5. Evaluates all incidents for severity, frequency, and probability of loss, and report as necessary to appropriate administration, committees, and personnel.
6. Develops and maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods for the appropriate areas.
7. Facilitates the investigation of clinical events in collaboration with the Chief Medical Officer, including
   1. Sentinel events, sentinel event near misses,
   2. significant adverse events, and all other identified potentially compensable events (patient, visitor, employee, and product)
   3. leads and/or participates in the development of root cause analyses as directed by the CMO.
8. Facilitate the development of clinical interventions and protocols based on risk stratification and evidence-based clinical guidelines.
9. Monitor UDS quality measures, focusing on current targeted improvements by entering scanned documentation as historical entries within the EHR.
10. Collaborate when needed in EHR training for staff and providers as requested.
11. Assist in clinical quality improvement projects as requested.

1. Clinical Audits, Investigations, and Process Improvement
2. Monitors industry trends and anticipates implications and opportunities.
3. Monitors analytics platform and proactively resolves issues.
4. Tracks and monitors progress and completion of certifications and accreditation.
5. Ensures compliance regarding clinical quality initiatives with necessary regulations and accreditation criteria including but not limited to:
   1. Health Resources and Services Administration (HRSA) requirements
   2. The Healthcare Effectiveness Data and Information Set (HEDIS)
   3. Centers for Medicare and Medicaid Services - HEDIS Star rating program
   4. Patient-Centered Medical Home (PCMH) certification standards
   5. HRSA Uniform Data Sets (UDS)
   6. Meaningful Use
   7. Patient satisfaction
   8. Grant requirement

1. Interagency Cooperation
2. In collaboration with the Chief Operating Officer, assists in monitoring existing programs/grants.
   1. Provides regular analysis of overall program development and effectiveness.
   2. Conducts midcourse corrections as required.
   3. Keeps senior leadership informed.
3. Develops pertinent curriculum, training, and tools/templates for staff to improve operational and patient services effectiveness.
   1. Collaborates with clinical leadership for implementation and monitoring.
4. Facilitates the work of the organization’s internal Quality and Patient Safety Committee and Quality Improvement Workgroups and takes primary responsibility for follow-through on committee/workgroup actions.
5. Provides applicable advice and improvement recommendations in partnership with Associate CMO as necessary to clinicians, care team members, and other staff members to improve the quality of care and close care gap

1. Quality Assurance and Improvement Oversight and Technical Assistance
2. Serves as the expert on quality assurance and improvement.
   1. Provides guidance to the Honor Community Health (HCH) team.
   2. Keep track of the latest developments that could impact HCH and immediately notify the leadership team of any important updates.
3. Develops, implements, and maintains policies and procedures related to the quality improvement program.
4. Collaborates with clinical leadership to develop, execute, and sustain the organization's quality strategy.
   1. Implements tactical quality and process improvement activities that involve all staff and services.
5. Assists the Chief Operating Officer in developing and maintaining the organization's key performance indicators (KPIs) including –
   1. Annual Quality Work Plan
   2. Quality Improvement Plan
   3. Reporting calendar
      1. Ensures timely data collection, aggregation, benchmarking, analysis, and reporting of operational and patient services processes and outcomes performance.
      2. Collects data efficiently, analyzes it, and reports on the performance of our operational and patient services processes and outcomes in a timely manner.
6. Collaborates with Directors and other members of the leadership team to communicate and educate staff regarding clinical quality initiatives including but not limited to Health Resources and Services Administration (HRSA) requirements, The Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare and Medicaid Services - HEDIS Star rating program, Patient-Centered Medical Home (PCMH) certification standards, Uniform Data Sets (UDS), Meaningful Use, patient satisfaction, and grant requirements.

What are we looking for?

• Licensed Practical Nurse (L.P.N), Associates Degree in Nursing (A.D.N.), Registered Nurse (R.N.) or Bachelor’s degree in nursing or other related health field is required. 
• A minimum of 2 years working within a quality program is required.
• Experience in a health care environment and process improvement required.
• Ability and/or willingness to obtain training and certification in quality/process improvement and risk management E.g. The Certified Professional in Healthcare Quality (CPHQ) and Certified Professional in Healthcare Risk Management (CPHRM).
• A flexible and positive attitude
• Ability to work in a fast-paced environment 
• Creating an excellent patient experience
• Patient focused mindset

What do we Offer?

• Competitive wages
• 401k with company match
• Medical, Dental and Vision insurance
• Free Life Insurance
• Free Short Term and Long Term Disability Insurance
• 4-6 Weeks Paid Time Off for Full-Time Employees
• Parental Leave
• Diversity Day and Holiday Pay
• Bereavement Leave
• Continuing Medical Education Allowance for Clinicians
• Free Malpractice Insurance
• License Reimbursement
• Employee Assistance Program
• Public Service Loan Forgiveness to all Full-Time Employees

Why work for Honor?

• Honor is a patient directed and community driven Federally Qualified Health Center.
• We ensure that patients come first by providing enabling services to assist patients with specific barriers to care such as transportation, translation, food security, and other social services.
• Our staff is passionate about providing all members of the community with access to quality health care regardless of their situation.

How to apply

Applicants must complete the full application through our career page at www.honorcommunityhealth.org/careers

Please note the selected candidate will be required to submit to a criminal record check and reference check.

Our Commitment to Diversity, Equity and Inclusion

The diversity of our people and patients is one of our greatest strengths, and inclusive workplace enables us to embrace that diversity to deliver the best services to our employee and patients. Honor Community Health is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, handicap, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items.