- Leads and participates in quality assurance and quality improvement projects within the clinics.
- Facilitates and participates in root cause analysis (RCA), and Plan, Do, Study, Act (PDSA) within the Clinics. This includes the tracking of action items and process improvement initiatives across the organization via project management tools, and in collaboration with the Medical Director and/or the administrative team.
- Operationally facilitates providers & staff compliance with HEDIS measures required by Managed Care organizations, as well as Uniform Data Systems (UDS) Clinical Quality Measures. Stays current with updates and best practices to address gaps in performance measures. Attends payor JOC meetings to ensure collaboration with external managed care partners. Works closely with the Director of Coding and/or Manager of Regulatory and Accreditation to address and align closing quality gaps and performance measures.
- Maintains current knowledge of healthcare standards of care and best practices; directs initiative implementation of same with key leaders.
- Conducts chart review and data abstraction in support of quality measurement, analysis, and improvement across the organization, as needed.
- Participates in clinic activities to ensure preparedness for accreditation and licensure audits/surveys.
- Manages requests for data and participates in the review of comprehensive quality management reports including utilization, outcome studies, scorecards and dashboards.
- Participates in summary reports of clinical measures and required regulatory/accreditation measures for administrative and clinical staff.
- Supports Health Resources and Services Administrations (HRSA) Grants, and related grant conditions, by tracking critical dates and/or deadlines.
- Manages quality initiatives implemented in the clinic collaborates with leadership to improve efficiencies and effectiveness of such processes, and assists with implementation of changes.
- Collaborate with the leadership team and EHR vendor for ongoing system optimization, process improvements, and ongoing support/updates.
- Tracks, trends and analyzes patient outcomes, makes recommendations and develops action programs to improve delivery and quality of care.
- Works closely with the risk management department in support of clinic risk, quality, and patient safety programs.
- Ensures efficiency of peer review processes and produces meaningful reports to evaluate the effectiveness of the peer review programs, including the use of statistical process tools, for continuous improvement clinic-wide.
- Manages the production, analysis, and presentation of relevant quality data to key individuals, committees, and leaders and provides guidance on opportunities for improvement.
- Continuously prioritizes organizational Quality/Performance Improvement management needs based upon assessment and reassessment of findings/data or populations served.
- Develop and provide Quality and Patient Safety education clinic-wide as well as to the entire organization as needed.
- Function as a Nurse in the clinic setting on an as-needed basis as part of the implementation of processes or for coverage.
- Emergency duty may be required of the incumbent including but not limited to: working in special needs or Red Cross shelters, performing other emergency duties responding to threats or disasters, man-made or natural as required.
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Quality Manager - West Palm Beach, United States - Health Care District of Palm Beach County
Description
This position collaborates with the Senior Leadership team on strategic planning, goal setting, department evaluations, and the implementation of strategic initiatives for the respective department. The Quality Manager works in partnership with the CL Brumback Primary Care Clinics administrative and medical staff leadership to implement and maintain quality initiatives, reporting, and policies, and procedures. This position is responsible for providing oversight, as well as coordinating and evaluating all facets of the CL Brumback Primary Care Clinics quality management and patient safety activities.
Education:
Bachelors Degree in nursing preferred, Masters Degree in same preferred.
Experience:
Previous management/leadership experience in quality and patient safety activities preferred. Knowledge of data abstraction, data analysis principles and chart review is preferred. Strong knowledge of HEDIS/clinical performance measures and experience in compliance and reporting preferred. Excellent communication and interpersonal skills. Proficient in the use of MS Word and Excel and the ability to learn and advance the skill through self-study modules is required.
Certification:
Certification in Healthcare Quality preferred.
Licensure:
Registered Nurse Registrations: N/A
Training:
Executive, leadership and health care management training is preferred.
Health Care District of Palm Beach County is proud to be an Equal Opportunity Employer and Drug Free Workplace. We embrace diversity and do not discriminate based onrace, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
