Executive RN Director of Clinical Excellence

AdventHealth • Full-time • Orlando, Florida, United States • 4w ago

All the benefits and perks you need for you and your family:

Benefits and Paid Days Off from Day One
Whole Person Wellbeing and Mental Health Resources
The role you’ll contribute:

The Executive Director of Clinical Excellence serves as the executive leader responsible for developing, managing, and continuously enhancing a comprehensive quality program that drives clinical excellence and high-value care delivery across the 8 hospitals in AdventHealth's Central Florida Division, South Region (CFD-South). This individual will provide broad oversight and strategic direction for all core aspects of quality, clinical outcomes, regulatory compliance, and public reporting of clinical performance. The Executive Director will collaborate closely with physician leaders, hospital executives, and nursing leaders to ensure alignment on quality priorities and develop strategies to optimize safe, high-quality, patient-centered care. They will liaise with medical staff, Institute and AHMG physician leaders to build relationships that drive physician engagement on evidence-based care, national best practices, and ensure that clinical performance is reflected in the highest ratings for AH CFD-South public reporting.

This position requires an influential quality leader who can understand complex data, identify improvement opportunities, and effectively navigate politically sensitive situations with diverse stakeholders. The ability to collaborate, influence change, and partner strategically with physicians and leaders is critical.

The Value You’ll Bring To The Team

Collaborates extensively with the Regional Chief Clinical Officer, Regional Chief Nursing Officer, Hospital Chief Medical Officers, Chief Nursing Officers, ancillary leaders, and physician leaders to drive engagement and performance on quality priorities and evidence-based care.
Serves as matrix leader for outcomes and quality leaders at each campus. Provides strategic direction on clinical excellence priorities for the region and leads the development of quality initiatives to improve clinical performance.
Responsible for ensuring AH CFD-South compliance and accuracy of all required quality reporting for AHCA and CMS. This includes overseeing all quality measures and attestations for the CFD-South region campuses.
Monitors performance in corporate accountabilities, including but not limited to mortality rates, healthcare associated infections, readmissions, and AHRQ patient safety indicators, and other clinical performance indicators. Establishes goals and initiatives to drive improvements.
Prepares for the regional Board Quality and Safety Committee meetings. Develops executive summary slides, compiles data reports, and builds corrective action plans as part of comprehensive performance updates.
Leads development of quality action plans for corporate accountability initiatives such as AH Clinical Excellence Review and AH Corporate Performance Review. Presents quality plans in executive forums as assigned.
Serves as subject matter expert on all areas of quality and clinical excellence performance including measure specifications. Responsible for forecasting changes to quality measures based on national landscape, regulatory, or payor requirements and developing strategic plans to meet clinical quality performance goals.
Ensures regulatory compliance with all applicable quality standards and regulations such as Det Norske Veritas, AHCA, and CMS requirements.
Provides complete operational and strategic management for quality budget across 8 hospitals, including staffing, contracts, and resources.
Recruits, hires, develops and retains high-performing quality management team for region with more than 2,900 acute care beds.

Minimum Qualifications

The expertise and experiences you’ll need to succeed:

Bachelor’s degree in nursing
Current valid State of Florida or multi state license as a Registered Nurse
Minimum five years’ progressive healthcare management experience
Quality program development, process improvement and project management
Experience with administrative quality databases (Vizient, Premier, Quantros, etc)
Experience with national quality programs (Leapfrog, CMS 5-Star, U.S. News, etc.)
Expert understanding of clinical quality, performance improvement, and regulatory compliance principles.
Knowledge of accreditation standards such as CMS, DNV, and state regulations.
Knowledge of change management and project management methodologies.
Excellent facilitation skills in various PI methodologies (Six Sigma, Lean, PDSA, etc.)

Preferred Qualifications

Master’s degree in Nursing or other healthcare-related field
Certified Professional in Healthcare Quality (CPHQ)
Lean Six Sigma Performance Improvement Certification

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical

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