Vice President OF Quality

Position Summary The Vice President of Quality & Clinical Informatics is the single accountable executive for the hospital's quality, performance improvement, patient safety, risk, regulatory and accreditation, and clinical informatics functions. The role leads the hospital-wide Quality Assessment and Performance Improvement (QAPI) program required under the CMS Conditions of Participation, owns survey readiness across CMS, The Joint Commission, and the New Jersey Department of Health, and directs optimization and clinical adoption of the Cerner electronic medical record. This is a working leadership role. The VP leads a small specialist team and is expected to be directly involved in the analysis, survey preparation, and improvement work, not only to oversee it. Reporting Relationships and Team Reports to: Chief Executive Officer Oversees (existing roles): Infection Preventionist, Quality and Performance Improvement Coordinator(s), Clinical Informatics Analyst, and one Data/Quality Analyst. Partners closely with: Chief Medical Officer, Chief Nursing Officer, Chief Operating Officer, the Director of Risk, Information Technology, Revenue Cycle, and Legal Counsel. Key Responsibilities Quality and Performance Improvement Lead and maintain the hospital-wide QAPI program, demonstrating measurable improvement in clinical outcomes and reduction of medical errors across all departments, including services furnished under contract or arrangement. Set quality metrics, targets, and reporting; build and maintain dashboards for leadership and the board quality committee. Manage participation in CMS and payer quality reporting and value-based programs. Apply structured improvement methods (root cause analysis, PDSA) and facilitate interdisciplinary improvement work. Integrate patient safety, risk, and event-reporting data owned by the Director of Risk into the QAPI program and improvement priorities. Regulatory and Accreditation Own survey readiness for CMS, The Joint Commission, and the New Jersey Department of Health, including mock surveys, tracers, and plans of correction. Serve as the primary organizational liaison during regulatory and accreditation surveys. Maintain policies and procedures aligned to current Conditions of Participation and accreditation standards. Infection Prevention and Antibiotic Stewardship (oversight) Ensure active, qualified infection prevention and antibiotic stewardship programs that meet 42 CFR 482.42, including a governing‑body‑appointed infection preventionist. Integrate infection prevention and stewardship findings into the QAPI program. Clinical Informatics Direct Cerner EMR workflow optimization, clinical adoption, and clinical decision support. Define clinical requirements and validate system builds and upgrades in partnership with Information Technology, which retains ownership of infrastructure and security. Safeguard data integrity for clinical and quality reporting. Artificial Intelligence (Clinical Adoption and Governance) Execute clinical adoption of AI tools in partnership with the CEO, who owns the AI clinical adoption vision, including workflow integration and clinician training within the EMR. Lead clinical validation of AI tools before and after deployment, and monitor their performance, safety, and clinical impact in use. Coordinate the clinical and quality side of AI governance, ensuring AI performance, safety events, and bias concerns are reviewed and fed into the QAPI program. Partner with the Chief Information Officer, who owns the technical implementation, integration, and security of AI tools. Data and Analytics Direct one analyst supporting quality, regulatory, and clinical reporting. Translate data into actionable insight for clinical and operational leaders. Leadership and Governance Report quality and safety performance to the CEO and the board quality committee. Lead a small specialist team and collaborate across clinical and operational departments. Support data‑driven, physician‑led quality governance. Qualifications Required Bachelor's degree in nursing, a clinical discipline, health administration, informatics, or a related field. Seven or more years of progressive quality and performance improvement leadership in an acute care hospital, including direct survey and accreditation experience. Working knowledge of CMS Conditions of Participation, Joint Commission standards, and state Department of Health requirements. Experience with EMR optimization and clinical informatics. Clinical licensure (RN preferred) strongly preferred. Non‑clinical candidates will be considered with substantial hospital quality leadership experience. Preferred Master's degree (MSN, MHA, MBA, MPH, or health informatics). Certified Professional in Healthcare Quality (CPHQ). Clinical informatics certification. Cerner experience. Experience in a community hospital serving a diverse, high‑need patient population. Core Competencies Data‑driven and comfortable working directly in the analysis. Direct, plain communicator with clinical and operational audiences. Composed and credible in front of surveyors, the board, and medical staff. Strong cross‑disciplinary collaboration and influence without direct authority. Salary Information The salary/hourly rate range for this position is $175,000 - $190,000. CareWell Health provides a salary/hourly rate range for all open positions to comply with New Jersey Law. The rates listed for each position is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). The salary range does not include bonuses/incentives, differential pay or other forms of compensation, which can be discussed in detail with your talent acquisition specialist. Benefits Health, Dental and Vision Insurance Basic Life and Disability Insurance Whole Life, Accident, Critical Illness and Hospital Indemnity Insurance Flexible Spending Accounts Employee Assistance Program 401(k) Paid Holidays and a generous Paid Time Off Plan #J-18808-Ljbffr