Job Summary
In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; contributing to the evaluation, design, and development of evidence-based guidelines, principles, and/or programs related to area of work as well as facilitating implementation efforts to reduce variation in clinical practice and optimize patient outcomes; assisting with the collection, analysis, report development, and presentation of clinical data for a variety of users including for state, federal, and local agencies; helping to provide education regarding the interpretation of compliance methods when preparing for regulatory reviews, the interpretation of regulatory requirements, and regional project goals; monitoring, reporting, and developing mitigation plans for all occurrences which may lead to medical center liability; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and serving as a liaison with applicable government agencies, regulatory agencies, and other organizations.
Essential Responsibilities
- Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
- Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
- Conducts data extraction, analyses, and presentations to support quality improvement efforts by: conducting statistical analysis to determine the reliability and confidence intervals for quality improvement evaluations and special projects; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; presenting quality improvement metric reports at the individual and team level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and documenting and analyzing trends, potential errors, and other analysis and reporting finds to the supervisors.
- Facilitates quality improvement and improvement risk management efforts by: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys; ensuring process improvements are compliant with established internal and external regulation requirements at the local level; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement; and exercising independent judgment to escalate high-risk issues and trends to appropriate entity for resolutions.
- Develops and utilizes quality improvement performance metrics by: developing performance metrics, standards, and methods to establish improvement success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved for assigned departments; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.
- Facilitates the development of quality improvement initiatives by: implementing methods and tools to develop stakeholders capabilities for process improvements; integrating the use of data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing and updating milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plan.
- Serves as the subject matter expert for quality improvement processes and regulations within assigned departments by: learning current internal policies and external regulations; participating on committees, projects to propose a course of action on the enforcement, development of policies or procedures of regulations and auditing processes; fostering collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; delivering educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage; and anticipating issues, weigh practical considerations in addressing issues and seek input from engagement manager/sponsor to resolve.
- Delivers stakeholder development and quality performance review efforts by: conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering and assisting in the development training and educational programs related to process improvement for quality improvement programs for stakeholders at the team level.
Knowledge, Skills and Abilities: (Core)
- Ambiguity/Uncertainty Management
- Attention to Detail
- Business Knowledge
- Communication
- Critical Thinking
- Cross-Group Collaboration
- Decision Making
- Dependability
- Diversity, Equity, and Inclusion Support
- Drives Results
- Facilitation Skills
- Health Care Industry
- Influencing Others
- Integrity
- Learning Agility
- Organizational Savvy
- Problem Solving
- Short- and Long-term Learning & Recall
- Teamwork
- Topic-Specific Communication
Knowledge, Skills and Abilities: (Functional)
- Clinical Quality Expertise
- Agile Methodologies
- Applied Data Analysis
- Compliance Management
- Development Planning
- Health Care Compliance
- Health Care Quality Standards
- Negotiation
- Process Mapping
- Project Management
- Quality Improvement
- Risk Assessment
- Risk Management
Minimum Qualifications
- Minimum one (1) year of experience in a leadership role with or without direct reports.
- Minimum two (2) years of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
- Minimum three (3) years of experience in a clinical setting, health care administration, or a directly related field.
- Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum four (4) years of experience in quality, performance improvement, customer service, or a directly related field OR Minimum seven (7) years of experience in quality, performance improvement, customer service, or a directly related field.
- Registered Nurse License (California)
Preferred Qualifications
- Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field.
- Health care clinical license from the practicing/applicable state (e.g., Registered Pharmacist (RPh), Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker).