Maintains current knowledge of national and community standards of high reliability science, patient safety and risk prevention and mitigation, professional clinical competency, and aligns accountabilities in conjunction with program-wide and regional patient safety, risk and other initiatives across the region.
Participates in goal development driven by national and regional priorities.
Supervises assigned staff.
Develops, reviews and revises Patient Safety/Risk Management plans, policies and procedures with staff and physicians in areas such as: national patient safety goals, required reporting, treatment of minors, workplace violence, informed consent, SIRI reporting; sentinel event & serious reportable adverse event management.
Co-Chairs the Patient Safety/Risk Management Committee, providing a leadership role in the development, oversight and implementation of an effective patient safety/risk management program. This includes the development of a committee charter, annual work plan, annual evaluation of the program, and quarterly reporting of the program's efficacy, barriers and accomplishments to the RQIC.
Oversees rapid response mechanisms and situation management procedures for onsite patient and/or member risk events , i.e. process for disclosing unanticipated adverse outcomes. This includes response to staff's needs and requests in advising and assisting with the appropriate disclosure of unanticipated adverse outcomes to members and families. Studies patient safety and risk events to identify causal factors and mitigation/prevention activities. Develops data systems to drive performance to create a high reliability region.
Oversees supporting documentation and preparation of patient safety and risk management activities in the survey process related to NCQA, MDQR, CMS, state and other regulatory standards. Develops and presents an annual report to the KFHP Board of Directors Quality Health Improvement Committee.
Directs, develops and implements an effective Patient Safety, Risk Management educational program for staff and practitioners. Collaborates with the Clinical and Nursing Education Department to provide CEU and CME in-services to all medical centers/departments on topics such as high reliability, patient safety practices, confidentiality, documentation, treatment of minors, depositions, informed consent, early resolution and written correspondence to members, families or next of kin and other topics as indicated.
Consults on subpoena handling, including contacting attorneys and setting up processes for review. Assists Quality Management staff and practitioners in developing responses to the Board of Medicine and Nursing regarding concerns or requests for more information. Advises and coaches Departments, medical staff, other practitioners in responding to members, families or next of kin matters, providing the best advice to protect everyone involved and to support an early resolution of issues/concerns.
Collaborates with key groups including legal team to mitigate risk, Quality Management Sr Director to prepare quarterly QHIC reports or responses to KFH/HP Board of Directors, and Member Services for complaint management data.
Hires, trains, supervises, counsels, disciplines, and terminates assigned staff as appropriate. Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff. Effectively meets budgetary goals and parameters.
Minimum ten (10) years of direct experience in the direction, management and analysis of patient safety/risk management in health care/managed care fields required.
Minimum eight (8) years of experience in the direct management and oversight of programs and staff required.
Minimum seven (7) years of experience with federal and state laws and regulations, as well as, TJC or CMS or AAAHC requirements required.
Master's degree in a health care, administration, business, clinical areaor a related fieldOR six (6) years of directly related experience required.
High School Diploma or General Education Development (GED) required
License, Certification, Registration
Licensed RN or other health care discipline licensure required.
Certification in risk management, quality or other health care competency required within one year.
Proven track record of developing and implementing major projects on time and within budget required.
Working and current knowledge of CMS, Patient Safety; Environmental Health and Safety required.
Proficient in computer applications including Microsoft Office Suite required.
Strong interpersonal skills with good verbal and written communication skills required.
Skills in problem-solving and collaboration with other professions/disciplines required.
Demonstrated experience in implementing initiatives or projects required.
Skill and experience in organizational change management required.
Demonstrated leadership skills required.
Demonstrated experience in complex strategy formulation and implementation required.
Managed care experience preferred.
NCQA, JCAHO, State survey experience with delegation background preferred.
Advanced degree in risk management, quality, nursing, public health, or related field preferred.
Broad knowledge and understanding of health care delivery in an ambulatory setting; electronic documentation systems related to all areas of health care preferred.