Manager of Clinical Quality and Patient Safety, Redding, CA
Manager of Clinical Quality and Patient Safety (RN)
Job Locations US-CA-Redding
Job ID 2019-1660
Category Health Services
The Manager of Clinical Quality and Patient Safety is responsible for managing key quality assurance and patient safety activities of the Quality Improvement Program. These include: Partnership HealthPlan’s facility site reviews and medical record reviews (Corporate lead), and potential quality issues and the peer review process (Northern Region lead). In addition, the Manager of Clinical Quality and Patient Safety serves as the Nurse Lead within the Northern Region QI department, providing clinical input and leadership across QI department programs and improvement projects.
Provides corporate oversight of Facility Site and Medical Record Reviews (FSR/MRR) for Partnership HealthPlan, with day-to-day operational responsibilities for the Northern Region. Specifically:
- Provides leadership and ensures the implementation of Northern Region reviews are timely and meet regulatory requirements;
- Serves as a Department of Health Care Services (DHCS) certified FSR/MRR Master Trainer; keeps current on state requirements and proposed changes related to FSR/MRR process by representing PHC on the state-wide Site Review Work Group (SRWG);
- Develops training materials and trains nurses and coordinators that are implementing facility site and medical record reviews;
- Monitors and reports FSR activity; identifies opportunities for improvement and helps develop improvement interventions;
- Presents results and recommendations for improvement to management;
- In partnership with Southern Region FSR leadership, develops key metrics by which to evaluate facility site and medical record reviews and to identify areas for improvement;
- Collaborates closely with the CMO and Southern Region FSR/MRR lead to ensure plan-wide coordination and standardization as needed.
Oversees Potential Quality Issues (PQIs) and Peer Review Process for Partnership HealthPlan’s Northern Region:
- Ensures that Northern Region cases are well prepared for review by the Peer Review Committee;
- Ensures compliance with state requirements;
- Leads implementation of IRR processes in Northern Region across nurse and physician reviewers;
- Responsible for training and education of PQI/Peer Review nurses in Northern Region;
- Collaborates closely with Corporate PQI/Peer Review lead, CMO, and Associate Medical Director for Quality to ensure continuous monitoring, evaluation, and improvement of the PQI and peer review processes;
Participates in and advises on QI department programs and improvement projects:
- Examples may include: join improvement teams and workgroups, provide guidance on pay for performance program including measurement and specification development;
- Share learnings from provider site visits and PQI findings to inform prioritization and development of improvement initiatives.
Supports HEDIS project and Medical Record chart abstraction on an as needed, ad hoc basis.
Leads a high performing team:
- Manages PICs (Performance Improvement Clinical Specialists) Nurses. Supports their development through training and by establishing clear goals, expectations, and performance metrics.
Serves as member of Northern Region QI/Analytics/Project Mgmt. department, Northern Region Leadership, cross-regional Quality and Performance Improvement Management, and Health Services Management Teams:
- Supports NR leadership in budget management, staffing decisions, and strategic and operational planning;
- Collaborates with cross-regional QI management team to ensure alignment of efforts across the department. Helps develop and manage communication feedback loops so findings from FSR/MRR and PQI/Peer Review processes inform improvement activities;
- Collaborates extensively with PICs leadership in Fairfield office, CMO, and Associate Medical Director for Quality;
- Attends Health Services Management Team meetings and stays informed of critical work across Health Services department.
SECONDARY DUTIES AND RESPONSIBILITIES
- Assures that processes for Quality Improvement projects are HIPAA compliant and implements any needed changes or upgrades.
- Accepts other responsibilities as determined by the needs of the QI Department.
*Candidates with experience in applying Quality Improvement methodologies and tools are preferred.
Education and Experience
Bachelor’s degree is required; Master’s degree in healthcare is strongly preferred. At least seven (7) years of experience in quality improvement operations and activities. Prior supervision of clinical staff is required. Experience with FSR/MRR and/or Peer Review is strongly desired.
Special Skills, Licenses and Certifications
Current CA RN license is required. Strong written and oral communication skills. Strong organization skills to work on multiple projects simultaneously within established time frames. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Ability to plan, implement, and report on quality management projects.
Work Environment And Physical Demands
More than 50% of work time is spent in front of a computer monitor. When necessary, the ability to lift, carry, or move manuals and reports, weighing up to 25 lbs. Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to function effectively with frequent interruptions and direction from multiple team members.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.