Risk & Quality Management Specialist (Health Care)

Job Description

Job Description

The Risk and Quality Management (QM) Manager is responsible for managing and analyzing risk management and performance improvement data, conducting risk management and performance improvement education programs, interfacing with the organization’s legal counsel, managing claims against the facility and administering the risk management and performance improvement programs on a day to day basis. The Risk and Quality Management Analyst II is responsible for assisting with the review and formulation of policy or organizational changes and making recommendations for final approval. The Risk and Quality Management Analyst II performs these functions with the objective of controlling and minimizing loss to protect the assets of and improving performance activities of the corporation.

Principal Duties and Responsibilities:

1. Coordinates the performance management system and process corporate-wide to improve patient care and organizational functions, using criteria for prioritizing improvement efforts;

2. Investigates and analyzes actual and potential risks in the corporation. Assess liability and probability of legal action;

3. Assists in processing summonses and complaints served on present and previous employees. Assists staff in completing necessary documents;

4. Reviews patient complaints that may be a source of potential legal action. Discusses and offers solutions when possible to resolve patient and/or family grievances against the corporation that are perceived as potential liability claims. Reviews and investigates employee complaints concerning potential problems;

5. Collects, evaluates, and distributes relevant data concerning patient injuries, aggregate data summaries, periodic trend analyses of performance improvement and other risk management data. Notify department heads and supervisors of potential or identified problem areas that concern quality issues or trends;

6. Recommends appropriate revisions to new or existing policies and procedures to prevent future occurrences to include revisions of the occurrence/incident reporting system, medical malpractice coverage/FTCA, sentinel events policies, and others. Recommend ways to eliminate risks through organization, equipment or other changes. Review and revise policies as appropriate to maintain adherence to current standards and requirements;

7. Directs and conducts educational sessions on risk management topics and provide educational performance improvement to the general staff. Direct and participate in corporate performance improvement education and training programs;

8. Assists with the coordination of accreditation activities and the implementation of standards for the performance management system and process agency-wide. Demonstrates working knowledge of The Joint Commission accreditation standards through competent interpretation and practical application of standards;

9. Develops and implements a corporate-wide performance improvement program for use in designing, measuring, assessing/evaluating, and improving patient care and organizational functions; aggregate and organize monitoring activities according to requirements of regulatory agencies and corporate guidelines;

10. Interacts and advises Administrative Staff, Providers, and Clinical Staff on matters involving performance improvement to facilitate recognition and resolution of issues. Serves as a quality management resource to staff by providing current knowledge-based information;

11. Prepares and reviews rate-based quality management reports and performance improvement findings, including outcomes, accurately and timely in accordance with reporting schedule for the Quality Management Committee. Monitors completion of reports by department heads with a report of non-submission of reports to Corporate Compliance Officer;

12. Serves as Co-Chairperson and documents proceedings (i.e. minutes, attendance records, recommendations, follow-up, etc.) of the Quality Management Committee. Establish a plan for resolution of issues and provide time lines;

13. Tracks and monitors reports of key measures; participates in quality assurance and clinical measure programs as directed for a lifecycle service;

14. Reports to the Corporate Compliance Officer all documented deficiencies and potential problem areas with follow-up and resolution of risk management and quality improvement issues;

15. Respects patient and/or family privacy according to Health Insurance Portability and Accountability Act (HIPAA) guidelines when discussing documentation of data;

16. Prepares and updates the corporation’s annual Quality Management Plan and Report documents;

17. Review charts and abstract data for performance improvement measures, mortality reviews, focused studies and quality of care review, screening appropriate cases for identification as potential quality concerns, according to established protocols. Prepare reports of statistical findings in accordance with reporting schedule for quality review activities. Provide information to Quality Management Committee, Executive Committee and Provider Staff Committee.

Qualifications:

1. Bachelor’s degree as a Licensed Social Worker, Registered Nurse, Licensed Practical Nurse.

2. Minimum of two (2) years experience required in industry and healthcare setting.

3. Quality Assurance Management experience preferred.

4. Strong verbal, written, analytical and persuasive skills,

5. Must have basic computer skills; computer skills as needed for data management and analysis.

6. Current Alabama Licensure.

What is Quality of Life Health Services?
- A private, non-profit corporation committed to community service.
- A medical home for you and your family.
- A health care provider with 24 locations serving 18 counties in Alabama.
- An organization with more than 47 years experience in health care.
- A primary care provider offering a broad base of ancillary services.
- A caring company serving to offer excellent customer service.

Company Description

What is Quality of Life Health Services?\r\n- A private, non-profit corporation committed to community service.\r\n- A medical home for you and your family.\r\n- A health care provider with 24 locations serving 18 counties in Alabama.\r\n- An organization with more than 47 years experience in health care.\r\n- A primary care provider offering a broad base of ancillary services.\r\n- A caring company serving to offer excellent customer service.