Job Description: Director of Care Management and Outcome Metrics
Position Summary:
The Director of Care Management and Outcome Metrics is responsible for designing, implementing, and overseeing clinical quality programs and monitoring frameworks that transition care delivery from volume to value. This role leads the strategic analysis of clinical outcomes, patient safety data, and healthcare metrics to optimize patient care and maximize performance under value-based care models. The Director collaborates closely with clinical leaders, data analysts, and operational teams to drive continuous quality improvement and ensure regulatory compliance.
Core Responsibilities:
Strategic Leadership & Quality Management- Design and execute the organization's outcomes-based healthcare strategy to align with value-based care models and reimbursement structures.- Establish clinical quality benchmarks, key performance indicators (KPIs), and monitoring protocols across all departments.- Lead cross-functional initiatives to reduce clinical variation, enhance patient safety, and improve overall health outcomes. Monitoring & Data Analytics- Oversee the tracking and reporting of clinical outcomes, readmission rates, patient satisfaction scores (HCAHPS), and electronic health record (EHR) data.- Partner with healthcare informatics and data teams to build predictive models, risk-stratify patient populations, and design real-time monitoring dashboards.- Translate complex health data into actionable insights for clinical staff and executive leadership. Regulatory Compliance & Performance- Ensure full compliance with CMS guidelines, Joint Commission standards, NCQA, and other state/federal healthcare regulations.- Manage and optimize performance for specific quality programs, such as MIPS, Accountable Care Organization (ACO) metrics, and alternative payment models.- Direct root-cause analysis and corrective action plans when clinical outcomes or monitoring thresholds fall below targets. Team Leadership & Collaboration- Provide strategic direction and mentorship to a team of quality specialists, clinical auditors, and data analysts.- Foster a culture of continuous improvement by educating medical and administrative staff on evidence-based practices and outcomes tracking. Qualifications & Skills
Education & Experience:
Master's degree in Healthcare Administration (MHA), Public Health (MPH), Nursing (MSN), Health Informatics, or a related field required. A clinical degree (MD, DO, or BSN) is highly preferred.- 7+ years of experience in healthcare quality management, clinical outcomes tracking, or healthcare analytics.- 3+ years of leadership experience managing teams within a hospital system, health insurance plan, or managed care organization. Technical & Core Competencies- Value-Based Care Expertise: Deep understanding of outcomes-based reimbursement models, population health management, and quality reporting frameworks.- Analytical Proficiency: Strong capability to work with health informatics, data visualization tools (e.g., Tableau, PowerBI), and EHR systems (e.g., Epic, Cerner).- Change Management: Proven track record of influencing clinical workflows and leading process improvement initiatives (Lean/Six Sigma certification is a plus).- Communication: Exceptional communication skills with the ability to present complex data trends to both medical staff and executive boards.
