Clinical Quality Specialist

Job Summary

The Clinical Quality Specialist provides oversight of the professional practice evaluation process, including ongoing professional practice (OPPE) and focused professional practice (FPPE), for practitioners in the health system, including physicians and advanced practice professionals (APP). Develops mechanisms to efficiently manage the professional practice evaluation process, including workflows, procedures, and compliance expectations consistent with Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC). Reviews cases, interprets, evaluates, and reports data to improve quality and patient care outcomes using problem-solving skills to identify potential areas of improvement. Collaborates with various departments for the development, building, and coordination of quality metrics used for OPPE.


Minimum Job Requirements:

Work Experience:

Three years of nursing experience with hands-on involvement in OPPE/FPPE Processes, data analysis, and performance evaluation. Experience collaborating with clinical leaders, interpreting metrics, and supporting peer review or medical staff committee activities is strongly preferred.


Extensive knowledge of CMS and TJC standards pertinent to medical staff policies and procedures, and other state regulatory rules and regulations.

License/Registration/Certification:

1. Current license to practice as a Registered Nurse in the State of Texas required.
2. Certified Professional in Healthcare Quality (CPHQ) preferred.

Education and Training:

Bachelor's degree in nursing required. Master's degree preferred.


Skills:

1. Knowledge of OPPE/FPPE requirements, credentialing standards, medical staff bylaws, and The Joint Commission (TJC) regulations.
2. Ability to communicate effectively, both orally and in writing, with APPs, physicians, committee members, and clinical leadership.
3. Strong analytical skills with the ability to collect, interpret, and present performance data from EMRs and other clinical systems.
4. Proficiency in utilizing performance improvement principles and applying them to evaluate quality issues.
5. Ability to conduct research and analyze data to solve complex problems.
6. Knowledge of hospital systems and organizational relationships, with a focus on regulatory compliance (TJC, TDH, and other accrediting agencies).
7. Skilled in using computer systems and related software applications, including credentialing or quality management tools.
8. Excellent critical thinking and problem-solving skills to address quality and operational challenges.
9. High attention to detail with strong organizational and documentation abilities.
10. Ability to manage complex workflows, prioritize tasks, and meet regulatory deadlines.
11. Ability to maintain confidentiality, exercise sound judgment, and handle sensitive peer-review information appropriately.
12. Bilingual in English/Spanish (preferred).