In performance of their respective tasks and duties, the Clinical Quality Assurance Manager is expected to conform to the following:
Uphold all principles of confidentiality and patient care to the fullest extent.
Adhere to all professional and ethical behavior standards of the healthcare industry.
Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
Possess cultural awareness and sensitivity.
Comply with all company policies and procedures, as well as all applicable laws.
Reporting to the Administrator, Medical Director directly and key corporate personnel indirectly, acting independently and in a team to promote quality assurance in health care delivery and clinical operations, meaningful quality improvement activities, and awareness of areas of potential risk and mitigation within the organization, the Clinical Quality Assurance/Quality Improvement Manager (Clinical QA/QI Manager) is responsible for the broad development, implementation and administration of quality improvement and quality assurance including outcome measurement.
This position serves as a content expert on performance improvement projects and measures, patient grievance resolution, and clinical and patient safety in compliance with the standards, rules and regulations of regulatory agencies, (e.g. DOH, CMS, AAAHC, etc.). Serving as the Chair of the Clinical Continuous Quality Improvement (CQI), the QA/AI Coordinator utilizes outside resources for complex questions regarding quality, accreditation and compliance while actively participating in all QA/QI collaborations. In addition to leading and assisting with organizational efforts to collect, analyze, and act on system data and outcomes, the Clinical QA/QI Manager also functions to summarize and present quality improvement information as well as train staff internally on quality program tools and goals utilized.
Essential Duties, functions & Responsibilities
Develop, administer, and monitor the day-to-day implementation of organizational Continuous Quality Improvement (CQI), including the development, maintenance, revision and coordinated approval of clinical policies and procedures for these functions and the corresponding quality tools used (e.g. risk assessments, Growth Opportunity objectives, templates, reports, etc.).
Serve as the Chairperson of Clinical Continuous Quality Improvement (CQIC) Committees (including Clinical CQI)
Provides input into the establishment of annual organizational goals for each function based on program intent, operational and environmental analysis, and prior year performance and incidents.
Coordinate, design and implement key clinical outcome model(s) as noted by Leadership. Participates in data extraction and preparation for submission of required data analysis and conclusions to oversight and/or accrediting bodies, including to the CEO and Health Board for monthly, quarterly, and annual reporting.
Participates in and leads (as required) the education of medical staff, employees, leadership on the quality performance indicators selected by the organization, focusing on the requirements and implications of these measures for safe clinical practice.
Performs retrospective and concurrent review of specific focused studies (including procedures, diagnosis and other studies) requested by medical staff, departments, leadership and committees.
Performs documentation audits, flags and documents variances for selected indicators and variables for focused studies and assists with the implementation of quality indicators for medical staff (e.g. chart and peer review, medication errors, critical quality incidents, etc.).
Coordinates receipt of, evaluation of, response assignment for, and closure of patient grievances/complaints, incident reports, adverse event investigations, root cause analysis, and other risk management processes requiring monitoring and resolution as provided in the policies and procedures.
Abstracts and reports performance improvement information in appropriate format to detect patterns and/or problems in the delivery of care
Monitors all new and existing CQI initiatives, providing comprehensive analyses and improvement ideas and integrating those concepts in the short- and long-term plans.
Conducts quality program orientations and provider network audits as required.
Maintains current knowledge of pertinent laws, standards, trends, tools, and techniques to maximize quality program effectiveness, including maintenance of applicable professional credentials through continuing education, as required.
May act as a direct supervisor for non-professional medical staffing.
May oversee certain departments as directed.
Perform other duties as assigned. MINIMUM MANDATORY qualifications
Bachelor’s degree in nursing, public health, or a related health service industry profession.
Two years (2) of healthcare experience, with exposure to and involvement in provider performance improvement activities.
Master's degree in public health, or a related health service industry profession.
Two (2) years of proven ability in the areas of leadership, healthcare regulations, QA/QI principles, education/research outcomes development.
Certified Professional in Healthcare Quality (CPHQ), Six Sigma Performance Improvement Certification, Lean Performance Improvement Certification, ACMPE (MGMA) and/or Licensed Healthcare Risk Manager (LHRM) designation(s) preferred.
MANDATORY KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of principles and policies of quality improvement programs including program structure, monitoring, evaluation, and reporting tools and processes.
Demonstrated ability to analyze information, problems, issues, situations an dprocedures to develop effective solution.
Knowledge of mathematics and relevant statistical techniques and ability to perform computations thereof.
Thorough understanding, knowledge and application of research, analysis, and assessment of compliance with federal regulations related to Medicare, Medicaid, HIPAA, Affordable Care Act, and other government laws and programs related to the healthcare industry.
Knowledge and understanding of the principles, procedures and associated regulations and standards for the delivery of rural, community-oriented health care delivery systems.
Computer literate and knowledgeable of various computer technologies and software including Word, Excel, and other comparable systems.
Self-motivated, goal oriented and flexibility to adapt to frequently shifting priorities.
Requires a professional image/demeanor as well as an extremely responsible working attitude with oral and written communication skills being an absolute necessity. Individual must exhibit the highest level of integrity and ethics.
Ability to maintain a high degree of confidentiality and discretion.
Frequently required to provide immediate response/assistance to the organization and its employees.
Clinical skills that facilitate active review and discussion of clinical documentation requirements and the provision of quality patient care as reflected in patient charts with other healthcare professional.
Knowledge of the Privacy Act, confidentiality and applicable rules and guidelines.
Extensive knowledge of appropriate accrediting and certification requirements, such as JCAHO, AAAHC, Medicare/Medicaid, OSHA, etc.
Ability to multi-task, work under conditions of stress and meet deadlines.
The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. This position may be exposed to certain health risks that are inherent when working within a health center facility.
The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding and reading. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors and staff.
There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues. Group presentation and education tasks are common.
All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
Base Salary: $60,000.00
Regular office hours: Monday - Friday, 8:00 AM to 5:00 PM; 7.5 paid holidays per year (off on all major holidays).
Competitive benefits including medical, dental, vision, 401k, STD/LTD, life, legal plan and supplemental medical plans.