Driscoll Children's Hospital
Quality Manager (Clinical RN)
Driscoll Children's Hospital, Corpus Christi, Texas, United States, 78417
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
Works collaboratively with Department Administrators, physicians, departmental leadership and all internal and external stakeholders to ensure exceptional delivery of care by continuously improving quality processes and standards. Works to ensure the delivery of high quality, developmentally appropriate patient and family centered care in a cost-effective manner for Driscoll Health Plan Members. Responsible for the continuous assessment and improvement of standardized quality of care and services delivered to Members through the assessment of all clinical outcomes.
The Quality Manager (Clinical RN) is a critical thinking professional who may be responsible for oversight and management of the Driscoll Health Plan Quality Assessment and Performance Improvement Program (QAPI), or Complaints and Accreditation Operations across all lines of business and service areas and reports to the Senior Director of Quality. Responsible for the continuous assessment and improvement of standardized quality of care delivered to Members through the assessment of clinical outcomes and for ensuring accuracy and timeliness of reporting and communication of results, trends and actions per state contract, regulatory and accreditation requirements. Ensures compliance with all state and federal laws, in addition to Accreditation standards within the scope of Quality. As a member of the Quality Leadership team, this professional may be responsible for oversight and success of all DHP quality/performance improvement activities, departmental clinical initiatives which may include but not limited to: quality programs and corporate quality initiatives, focused audits, quality liaison activities, PIPs, QIPs, Quality Concerns, strategic goals, implementation, maintenance and reporting of processes and outcomes related to Complaints and Accreditation etc.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.Maintains utmost level of confidentiality at all times.Adheres to all Driscoll Health System and Driscoll Health Plan policies and procedures.Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.Manages Quality programs, processes and resources, communicates productivity expectations and balances workload to achieve stakeholder satisfaction through prompt/accurate handling/escalation of concerns.Serves as a content model expert, liaison, and mentor to team in regard to Driscoll Health Plan policies and procedures, regulatory and accreditation requirements.Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals.Ensures work of team meets federal and state requirements and quality measures, with respect to Quality.Assists with development and management of policies/procedures/workflows/platforms/resources as needed, in conjunction with Accreditation/Reaccreditation and Quality scope of responsibility.Identifies and reports on trends involving non-clinical & clinical issues and recommends solutions.Performs other duties as assigned to achieve overall Organizational and Departmental Goals.Assures accurate and timely submission of any/all Quality driven Reporting requirements.Oversees related projects and contracts that support Quality Programs.Assists with development of and adherence to Departmental budget.Researches issues utilizing systems and clinical assessment skills, knowledge in the decision making process regarding health care services and care provided to members.Prepares executive narratives, graphs, flowcharts etc., for presentations and audits for all stakeholders, including but not limited to; DHP Leadership, regulatory, and accreditation entities.Manages assigned DHP policies and process to ensure documents remain current and compliant with federal, state, contractual and accreditation requirements.Develops and maintains an educational/development program for employees, members, and providers regarding DHP Quality Programs and processes.Develops quality control program and conducts ongoing outcomes evaluation for improvement opportunities.Leads change efforts while managing transitions within a team.Interfaces with consultants and stakeholders to ensure accurate interpretation and compliance with Accreditation standardsQuality Manager(s) individual scope of responsibility may include:
Quality Program (QAPI);
Conduct medical record reviews as necessary, for any/all Quality Program scope functions.Oversees the Health and Human Services Commission (HHSC) Performance Improvement Projects (PIPs) that are developed annually, as well as QIPs as required by URAC.Oversees Quality Concern process.Interfaces with internal and external stakeholders with regard to process improvement and/or quality outcome opportunities identified through quality operations (PIPs, quality concerns, quality referrals, etc.) resolution processes, trending Root Cause Analysis (RCAs), and Quality Improvement projects.Quality Processes (Complaints & Accreditation)
Participates in the analysis, processing and resolution of Complaints & Provider Disputes when not actively managing staff.Assists in analysis of data, identification of trends/concerns and preparation of recommendations for improvements as indicated in analyzed data.Develops quality control program and conducts ongoing outcomes evaluation for improvement opportunities to assure constant state of readiness for accreditation.Interfaces with internal and external stakeholders with regard to process improvement and/or quality outcome opportunities identified through grievance (complaints, concerns, quality referrals) resolution processes, trending Root Cause Analysis (RCAs), and Quality Improvement projects.Develops and Manages effective Accreditation audit programSupervisory Responsibilities:
Effectively administers performance management system including: goal setting, assesses competency, progressive disciplineStrong knowledge of and effectiveness in administering health plan policies and procedures.Responsible for sound management of human resources.Makes and implements decisions compatible with organizational goals.Maintains composure, effectiveness, and flexibility under pressure.Appropriately delegates duties as necessarySupervises the following job classes: Quality Management team (RN's, LVN's, Professionals, Administrative Support Personnel)English Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information and respond to questions from management, clients, customers, and the general public.Exceptional writing skills. Ability to write reports, complaint/regulatory agency correspondence, and policy/procedure manuals, educational materials,Education and/or Experience:
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.2 years Clinical, Quality, or Regulatory experienceProven Leadership Experience requiredPreferred:
Three (3) year previous work history with a managed care organization preferred.Working knowledge of Accreditation preferred or must be acquired within six (6) months of employment.Experience in interpretation and implementation of regulatory and accrediting body requirements.Experience in quality improvement activities within in acute care/managed care setting preferredExperience with computer programs, including Microsoft Office programs (Word, Excel, and Power Point).Preferred: PDSA PI team experienceCertificates, Licenses, Registrations:
Current and active unrestricted Registered Nurse Licensure in the state of Texas
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
Works collaboratively with Department Administrators, physicians, departmental leadership and all internal and external stakeholders to ensure exceptional delivery of care by continuously improving quality processes and standards. Works to ensure the delivery of high quality, developmentally appropriate patient and family centered care in a cost-effective manner for Driscoll Health Plan Members. Responsible for the continuous assessment and improvement of standardized quality of care and services delivered to Members through the assessment of all clinical outcomes.
The Quality Manager (Clinical RN) is a critical thinking professional who may be responsible for oversight and management of the Driscoll Health Plan Quality Assessment and Performance Improvement Program (QAPI), or Complaints and Accreditation Operations across all lines of business and service areas and reports to the Senior Director of Quality. Responsible for the continuous assessment and improvement of standardized quality of care delivered to Members through the assessment of clinical outcomes and for ensuring accuracy and timeliness of reporting and communication of results, trends and actions per state contract, regulatory and accreditation requirements. Ensures compliance with all state and federal laws, in addition to Accreditation standards within the scope of Quality. As a member of the Quality Leadership team, this professional may be responsible for oversight and success of all DHP quality/performance improvement activities, departmental clinical initiatives which may include but not limited to: quality programs and corporate quality initiatives, focused audits, quality liaison activities, PIPs, QIPs, Quality Concerns, strategic goals, implementation, maintenance and reporting of processes and outcomes related to Complaints and Accreditation etc.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.Maintains utmost level of confidentiality at all times.Adheres to all Driscoll Health System and Driscoll Health Plan policies and procedures.Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.Manages Quality programs, processes and resources, communicates productivity expectations and balances workload to achieve stakeholder satisfaction through prompt/accurate handling/escalation of concerns.Serves as a content model expert, liaison, and mentor to team in regard to Driscoll Health Plan policies and procedures, regulatory and accreditation requirements.Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals.Ensures work of team meets federal and state requirements and quality measures, with respect to Quality.Assists with development and management of policies/procedures/workflows/platforms/resources as needed, in conjunction with Accreditation/Reaccreditation and Quality scope of responsibility.Identifies and reports on trends involving non-clinical & clinical issues and recommends solutions.Performs other duties as assigned to achieve overall Organizational and Departmental Goals.Assures accurate and timely submission of any/all Quality driven Reporting requirements.Oversees related projects and contracts that support Quality Programs.Assists with development of and adherence to Departmental budget.Researches issues utilizing systems and clinical assessment skills, knowledge in the decision making process regarding health care services and care provided to members.Prepares executive narratives, graphs, flowcharts etc., for presentations and audits for all stakeholders, including but not limited to; DHP Leadership, regulatory, and accreditation entities.Manages assigned DHP policies and process to ensure documents remain current and compliant with federal, state, contractual and accreditation requirements.Develops and maintains an educational/development program for employees, members, and providers regarding DHP Quality Programs and processes.Develops quality control program and conducts ongoing outcomes evaluation for improvement opportunities.Leads change efforts while managing transitions within a team.Interfaces with consultants and stakeholders to ensure accurate interpretation and compliance with Accreditation standardsQuality Manager(s) individual scope of responsibility may include:
Quality Program (QAPI);
Conduct medical record reviews as necessary, for any/all Quality Program scope functions.Oversees the Health and Human Services Commission (HHSC) Performance Improvement Projects (PIPs) that are developed annually, as well as QIPs as required by URAC.Oversees Quality Concern process.Interfaces with internal and external stakeholders with regard to process improvement and/or quality outcome opportunities identified through quality operations (PIPs, quality concerns, quality referrals, etc.) resolution processes, trending Root Cause Analysis (RCAs), and Quality Improvement projects.Quality Processes (Complaints & Accreditation)
Participates in the analysis, processing and resolution of Complaints & Provider Disputes when not actively managing staff.Assists in analysis of data, identification of trends/concerns and preparation of recommendations for improvements as indicated in analyzed data.Develops quality control program and conducts ongoing outcomes evaluation for improvement opportunities to assure constant state of readiness for accreditation.Interfaces with internal and external stakeholders with regard to process improvement and/or quality outcome opportunities identified through grievance (complaints, concerns, quality referrals) resolution processes, trending Root Cause Analysis (RCAs), and Quality Improvement projects.Develops and Manages effective Accreditation audit programSupervisory Responsibilities:
Effectively administers performance management system including: goal setting, assesses competency, progressive disciplineStrong knowledge of and effectiveness in administering health plan policies and procedures.Responsible for sound management of human resources.Makes and implements decisions compatible with organizational goals.Maintains composure, effectiveness, and flexibility under pressure.Appropriately delegates duties as necessarySupervises the following job classes: Quality Management team (RN's, LVN's, Professionals, Administrative Support Personnel)English Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information and respond to questions from management, clients, customers, and the general public.Exceptional writing skills. Ability to write reports, complaint/regulatory agency correspondence, and policy/procedure manuals, educational materials,Education and/or Experience:
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.2 years Clinical, Quality, or Regulatory experienceProven Leadership Experience requiredPreferred:
Three (3) year previous work history with a managed care organization preferred.Working knowledge of Accreditation preferred or must be acquired within six (6) months of employment.Experience in interpretation and implementation of regulatory and accrediting body requirements.Experience in quality improvement activities within in acute care/managed care setting preferredExperience with computer programs, including Microsoft Office programs (Word, Excel, and Power Point).Preferred: PDSA PI team experienceCertificates, Licenses, Registrations:
Current and active unrestricted Registered Nurse Licensure in the state of Texas