| Purpose: |
| |
Under general supervision, creates, administers and coordinates the department's quality/risk management program(s) and plan development, data collection, data evaluation, and reporting of findings relative to specified quality improvement and risk management activities within a health care related service and makes recommendations to administration about opportunities for quality management. |
| Duties, Functions and Responsibilities: |
| |
Essential duties and functions, pursuant to the Americans with Disabilities Act, may include the following. Other related duties may be assigned.
- In cooperation with the Executive Compliance and Quality Committee coordinates all quality/risk management activities for the department.
- Under general supervision, coordinates the review, revision, and development of the QM Program and Plan including the methods and procedures for implementing the plan.
- Monitors and maintains outcome information for department areas including all aspects of QM: complaints, compliments, monitors of processes and procedures, and performance indicators, identifying patterns and trends and opportunities for improvements and recommending changes.
- Maintains documents and records according to state and federal health care standards.
- Participates in the planning of professional education programs, orientation, and training.
- Monitors credentialing of staff through verification, maintenance, and audit of credentialing, privileges, certifications, and training
- Coordinates provider enrollment in third party payor systems.
- Facilitates and implements workplace safety/risk management programs annually.
- Collaborates with external business associates regarding quality and risk management activities.
- Participates in management staff meetings.
- Develop policies and procedures necessary to carry out assigned quality, risk management, enrollment and credentialing processes.
- Performs other related projects and duties as assigned.
|
| Responsibilities - Supervisor and/or Leadership Exercised: |
| |
- Responsible for the full range of supervisory activities including selection, training, evaluation, counseling, and recommendation for dismissal
|
| Knowledge, Skills, and Abilities: |
| |
Must possess required knowledge, skills, abilities, and experience and be able to explain and demonstrate, with or without reasonable accommodations, that the essential functions of the job can be performed.
- Knowledge/expertise in utilization and quality review and risk management;
- Knowledge of data collection, analysis, and synthesis techniques.
- Knowledge of accreditation and certification requirements and standards.
- Knowledge of quality management practices and procedures within an inpatient and outpatient patient care environment.
- Knowledge of medical provider credentialing, provider enrollment, and accreditation principles, processes, procedures, and documentation.
- Skill in the use of personal computers utilizing word processing, spreadsheets, and databases .
- Skill in records maintenance and analysis
- Skill in establishing effective and constructive working relationships with departmental personnel and the general public.
- Strong organizational and creativity skills in program development.
|
| Minimum Qualifications: |
| |
- Graduation from an accredited school of nursing, four (4) years of nursing experience in two (2) or more of the following areas: Primary Care; Managed /Coordinated Health Care setting; Discharge Planning; UM/QM; Health; Risk Management.
|
| Licenses and Certifications Required: |
| |
- Current License to practice professional nursing in the State of Texas.
|
