Quality & Safety Improvement Consultant IV, Clinical Quality Consulting (KFH/HP)

Description : Job Summary :

• In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control;
• contributing to the evaluation, design, and development of evidence-based guidelines, principles, and / or programs related to area of work as well as facilitating implementation efforts to reduce variation in clinical practice and optimize patient outcomes;
• assisting with the collection, analysis, report development, and presentation of clinical data for a variety of users including for state, federal, and local agencies;
• helping to provide education regarding the interpretation of compliance methods when preparing for regulatory reviews, the interpretation of regulatory requirements, and regional project goals;
• monitoring, reporting, and developing mitigation plans for all occurrences which may lead to medical center liability; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards;

and serving as a liaison with applicable government agencies, regulatory agencies, and other organizations.

Essential Responsibilities :

• Promotes learning in others by proactively providing and / or developing information, resources, advice, and expertise with coworkers and members;
• builds relationships with cross-functional / external stakeholders and customers. Listens to, seeks, and addresses performance feedback;
• proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses;
• leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities;

adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes.

Facilitates team collaboration to support a business outcome.

• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions;
• encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and / or externally to achieve effective business decisions;

provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results.

Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines.

Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.

• Conducts data extraction, analyses, and presentations to support quality improvement efforts by : conducting statistical analysis to determine the reliability and confidence intervals for quality improvement evaluations and special projects;
• creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; presenting quality improvement metric reports at the individual and team level to demonstrate improvements and effectiveness of quality improvement programs into specified formats;

and documenting and analyzing trends, potential errors, and other analysis and reporting finds to the supervisors.

• Facilitates quality improvement and improvement risk management efforts by : assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys;
• ensuring process improvements are compliant with established internal and external regulation requirements at the local level;
• conducting root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement;

and exercising independent judgment to escalate high-risk issues and trends to appropriate entity for resolutions.

• Develops and utilizes quality improvement performance metrics by : developing performance metrics, standards, and methods to establish improvement success;
• collaborating with multiple stakeholders, often with competing / conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved for assigned departments;

and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.

• Facilitates the development of quality improvement initiatives by : implementing methods and tools to develop stakeholders capabilities for process improvements;
• integrating the use of data-driven improvement principles, tools, and problem-solving methods, including Lean / Six-Sigma concepts and techniques using quality improvement metrics;

and developing and updating milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plan.

• Serves as the subject matter expert for quality improvement processes and regulations within assigned departments by : learning current internal policies and external regulations;
• participating on committees, projects to propose a course of action on the enforcement, development of policies or procedures of regulations and auditing processes;
• fostering collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes;
• delivering educational programs to raise awareness for regulation requirement, internal concerns, and system / database usage;

and anticipating issues, weigh practical considerations in addressing issues and seek input from engagement manager / sponsor to resolve.

Delivers stakeholder development and quality performance review efforts by : conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement;

identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering and assisting in the development training and educational programs related to process improvement for quality improvement programs for stakeholders at the team level.

Minimum Qualifications :

• Minimum one (1) year of experience in a leadership role with or without direct reports.
• Minimum two (2) years of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
• Minimum three (3) years of experience in a clinical setting, health care administration, or a directly related field.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum four (4) years of experience in quality, performance improvement, customer service, or a directly related field OR Minimum seven (7) years of experience in heath care quality assurance / improvement or a directly related field.
• Registered Nurse License (in the state where care is provided)

Additional Requirements :

• Knowledge, Skills, and Abilities (KSAs) : Clinical Quality Expertise; Negotiation; Risk Management; Compliance Management;
• Health Care Compliance; Applied Data Analysis; Health Care Quality Standards; Quality Improvement; Development Planning;

Agile Methodologies; Process Mapping; Project Management; Risk Assessment

Preferred Qualifications :

• Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field.
• Health care clinical license from the practicing / applicable state (e.g., Registered Pharmacist (RPh), Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker).
30+ days ago