Clinical Quality Program Manager – Sparta, NJ

This position reports to and assists the VP of Clinical Affairs, to fully develop, implement, integrate, and maintain the RCCA Patient Centered Oncology Medical Home Model of Care. Responsible for implementing and managing RCCA’s Clinical Programs that supports the Model of Care that is aimed at providing safe, reliable and the highest quality of care to patients and families who receive care from RCCA practices. Accountable for ensuring the Clinical Programs meet the requirements and outcomes of payment arrangements entered into by RCCA including but not limited to the Oncology Model of Care (OCM), Merit-based Incentive Payment System (MIPS) and other Value-based Shared Savings Programs with public and commercial insurers. Constantly measures and monitors the effectiveness of programs and initiatives in place to ensure structures and processes fully support desired patient outcomes. Works very closely with assigned division and partners as well as RCCA leadership to advance the goals of RCCA as an organization. Utilizes continuous quality improvement process, techniques and state of the art technology to identify gaps in care processes, opportunities to decrease overall costs in care, excel in quality measures and improve overall patient experience with cancer care in the assigned RCCA division and practices.

  • Carry out timely assessments and/or audits of performance of clinical quality including access, cost and patient experience measures, of assigned division and practices compared to targets and benchmarks
  • Analyze results of assessments and any programmatic audits and initiate plan of correction to address gaps to goals
  • Communicate, educate and work with divisions and practices regarding clinical programs and initiatives put in place to meet OCM, MIPS and other value based payer programs requirements such as Practice Redesign and Clinical Improvement Activities
  • Lead division and practice specific interventions to ensure timely access, appropriate site of services, including but not limited to Triage, care management/care coordination and other patient navigation services
  • Develop standardized referral workflows to behavioral health agencies, community organizations and agencies supporting survivorship and where appropriate, workflows to identify patients needing advance care planning and end of life conversations
  • Serve as resource and expert for new practices that are joining RCCA and assist in their successful integration to RCCA
  • Participate in conference calls, meetings, webinars sponsored by CMS, other payers and national cancer care organizations to ensure RCCA’s standards of care are updated, maintained and aligned with national and where appropriate, international standards and best practices
  • RN or equivalent health care professional
  • Minimum 3 years’ experience in acute care setting, ambulatory physician practice management and/or administration of health plan benefits and other payer experience
  • Knowledge and experience in continuous quality improvement process and other cyclical data driven performance improvement method
  • Oncology practice experience a plus
  • Knowledge of MACRA, MIPS, OCM and other value based programs a plus
  • Experience working with community care organizations especially supporting cancer care a plus
  • Leadership and ability to influence others to work as a Team
  • Organized, detail oriented, flexible
  • Self-starter, able to start initiatives and work with minimal supervision
  • Ability to anticipate practice and division needs based on data
  • Project Management skills
  • Excellent oral and written communications skills
  • Bachelor of Science in Nursing or related health care degree
  • Certification in quality and/or project management preferred
  • Masters degree preferred
  • Sits constantly with occasional walking
  • Frequent travel to headquarters and practices and divisions
  • Medical and business facilities