The manager is responsible for the day-to-day management of the organization’s quality and safety performance. The manager will promote interdisciplinary collaboration and teamwork to ensure excellence in patient centered care in these locations related to core focus areas of regulatory compliance, infection prevention, patient experience, patient safety, high reliability, quality assurance, and clinical quality improvement. Key internal customers include clinical practitioners/applicants, physician leaders, and the senior administration team. Performance will be held to high expectations of patients, organizational leaders, the Board of Directors, regulatory entities such as The Joint Commission and OHFLAC, payors, and others with vested interest. Participation and leadership in health system initiatives related to these core focus areas will be required
MINIMUM QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor’s degree
OR Associate’s Degree in a healthcare field AND three (3) years supervisory experience.
PREFERRED QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Current West Virginia licensure in area of practice.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Assists in identifying, developing, implementing and monitoring of quality activities related to core focus areas of regulatory compliance, infection prevention, patient experience, patient safety, high reliability, quality assurance, and clinical quality improvement on relevant campuses.
2. Establishes and executes mechanisms for continuous data collection, analysis, and reporting of quality indicators to government agencies, payors, and vendors as well as internal collaborating partners from HIM, Finance, Coding, Pharmacy, Employee Health, and Human Resources.
3. Develops performance improvement initiatives throughout the institution and supports WVUHS and WVUH strategic initiatives.
4. Works in collaboration with the interdisciplinary health care team to support resource utilization and quality improvement.
5. Prepares the institution to successfully meet Joint Commission standards and Centers for Medicare and Medicaid Services (CMS) conditions of participation.
6. Supports safety culture through development, education, and accountability of just culture for all organizational leaders.
7. Promotes patient safety reporting, investigation, and follow up with front-line employees, leaders, and multidisciplinary teams.
8. Promotes and supports culture of safety through unit/division-based teams by supporting with coordination, education, and follow up with front-line led unit safety teams (CUSP).
9. Provides education and support of high reliability principles built into every discipline at every level of the organization.
10. Guides frontline staff in promoting a positive patient experience, takes the lead in implementing infection prevention strategies for the team and organization, conducts surveillance for their effectiveness, and provides education and guidance to collaborative teams in core areas.
11. Performs administrative functions for the Center of Quality Outcomes including, but not limited to, preparation and management of budget, strategic planning, office organization and other management functions.
12. Review and analyze departmental responsibility statements, labor reports monthly.
13. Participates in selection and hiring of qualified individuals and evaluates the effectiveness of employees on ongoing basis.
14. Provides ongoing performance reviews that provide objective, constructive feedback regarding strengths and opportunities for improvement, including departmental plans for each employee. Employees may include disciplines of nursing, respiratory therapy, pharmacy, public health, healthcare administration, and others.
15. Coaches and counsels to correct identified performance deficiencies, developing plans which establish goals, provides follow-up.
16. Facilitates the professional development of staff and self.
17. Assists Quality Leaders in developing and monitoring short-term goal setting and long-range plans for the department.
18. Attends to a variety of administrative details such as keeping informed of departmental/division activities, transmitting information, developing, implementing, and interpreting policies and procedures and monitoring day to day operations of the functional area to which assigned.
19. Collaborates with Associate Chief Quality Officers and Physician Quality Medical Directors of each service/program.
20. Works collaboratively with adult and pediatric teams from Population Health, Ambulatory services, Nursing Services, Surgical Services, Inpatient services, and ancillary services such as pharmacy, nutrition, and environmental services.
21. Participates and able to lead system quality initiatives in core focus areas.
22. Represents the Center for Quality Outcomes and participates in system initiatives related to collaborative teams.
23. Responsible for seeking input from direct Quality leaders and keeping department peer leaders and other Quality leaders informed of core areas and projects with direct oversight.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Office setting Hospital setting
SKILLS & ABILILTIES:
1. Assertiveness and negotiation skills.
2. Ability to respond to emergency situations in a calm, professional manner.
3. Communicates clearly and effectively orally and in writing.
4. Ability to learn financial, technical, and professional skills.
5. Interest and experience in team building, emotional intelligence, and ability to apply leadership skills to a variety of situations.
6. Flexibility.
7. Diplomacy.
8. Analysis and research methods.
9. Ability to use MS word, excel, access and other software to collect, analyze, and present data.
10. Demonstrates creativity in addressing complex issues.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
WVUH West Virginia University Hospitals
Cost Center:
405 WVUH Quality Management
Address:
1 Medical Center Drive
Morgantown
West Virginia
Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
