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7M
7500 Methodist Medical Group
Director, Clinical Quality & Payor Strategy
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What they do
A Clinical Quality Manager ensures that the quality of the work in a clinical environment is consistent and meets government and industry standards as well as customer expectations. Verifies compliance with health and safety regulations. Coordinates all activities related to quality assurance and monitoring and revises existing processes in order to increase efficiency.
$121,586 / year median in Tennessee
Job Description
If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One! We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we've served the health care needs of the people of Memphis and the Mid-South. The Director, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. Collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values. Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence. A Brief Overview The Director, Clinical Quality & Payor Strategy is responsible for leading strategic initiatives and operational execution across multiple Medicare Advantage and value-based care programs. This role serves as a subject matter expert in quality metrics, electronic health record workflows, and payer partnerships, driving performance improvement and alignment with organizational goals. Collaborates with internal teams, external partners, and payors to optimize care delivery, enhance patient outcomes, and ensure compliance with CMS-aligned models. This includes translating payor requirements into actionable workflows, monitoring performance and visit compliance, and implementing feedback loops that support continuous improvement. Models appropriate behavior as exemplified in MLH Mission, Vision and Values. What you will do Leads strategic planning and execution of value-based quality initiatives across all payors (CMS, Medicare Advantage, commercial). Serves as subject matter expert for internal quality metrics and EHR workflows, providing education, troubleshooting, and optimization support. Responsible for achieving quality performance for ACOs, coordinating efforts with payors, Healthchoice, and physicians. Develops and manages operational workflows for strategic programs including UHC Fastpass, MdRev, FindHelp, and Aledade, ensuring alignment with organizational goals. Develops and drives ongoing management of operational workflows for chronic care management, remote patient monitoring, patient-centered medical home, and transition of care. Coordinates with external partners and internal stakeholders to expand services, improve care delivery, and support program growth. Facilitates quality governance by organizing committee meetings, preparing agendas, and presenting updates. Provides strategic and operational support to Population Health teams, including clinical staff and program managers. Monitors compliance with payor-specific visit requirements and documentation standards, ensuring alignment with CMS and contract expectations. Partners with Decision Support teams which provide performance tracking and feedback mechanisms to support continuous improvement across clinics and teams to maximize incentives and minimize penalties. Ensures internal data feeds are established and active from EHR to all payor platforms in order to streamline quality reporting. Collaborates with IT and clinical teams to optimize EHR workflows that support care gap closure and quality reporting. Represents the organization in meetings with ACOs and Medicare Advantage payors to drive performance and strategic alignment. Education/Formal Training Requirements Required
- Bachelor's Degree Healthcare Administration Preferred
- Bachelor's Degree Nursing Preferred
- Bachelor's Degree Public Health Preferred
- Master's Degree Work Experience Requirements Required
- experience in Medicare and Value-Based Programs 7-9 years Required
- Proven experience in people management and program management Preferred
- Experience with Epic EHR and population health tools Knowledge, Skills and Abilities Expertise with Medicare Advantage payors, ACO structures, and CMS-aligned quality frameworks.
- exerting up to 25 lbs.