Clinical Director, Risk Management, Accreditation, Regulatory and Licensing - 21718805
Recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, their mission is to provide high-quality, affordable health care services and to improve the health of their members and the communities they serve. Currently serving 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Their expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management.
Accountable for direction and implementation of activities and programs for hospital, ambulatory sites, associated alliance hospitals and other non-KFH facilities in one or more of the following areas: accreditation, risk management, and infection control. Aligns programs with performance initiatives and strategic priorities as defined by leadership. Develops strong collaborative leadership relationships with TPMG, external regulatory agencies, accreditation bodies, employer groups. Directs and implements organization-wide systems and processes for improvement, in collaboration with clinical and administrative personnel.
- Directs Medical Center activities and programs for hospital and ambulatory sites which include quality, as well as other focus areas such as accreditation, regulatory, risk, patient safety and/or infection control.
- Uses clinical licensure to evaluate and train registered nurses on performance and processes.
- Develops action plans for improvement of nursing practice.
- Establishes and maintains highly effective working relationships with key stakeholders and departments, including physicians, clinical and administrative leaders, front-line staff, and external regulatory and accrediting bodies.
- Directs the daily operations of the department, including, allocating resources and priorities for staff, facilitating team development; motivation and problem solving; establishing and meeting department and organizational goals and ensuring workplace safety initiatives are implemented.
- Hires, orients, develops, coaches, appraises, rewards and retains competent personnel. Manages the department budget.
- Directs programs that are consistent with cultural diversity, healthcare literacy issues and language.
- Directs and manages a strategic data management program and utilizes data to improve performance of all worker and patient safety programs.
- Applies the appropriate performance improvement methodology to address improvement opportunity (eg. MFI, Lean DMAIC).
- Plans and directs the implementation of programs across the facility, which encompass strategic planning for the achievement of quality outcomes.
- Assists leader with reports on member utilization, network quality and medical staff credentialing/privileging functions, contract quality measures contained in the service area contracts, the care and service outcomes of contracted practitioner/provider organizations, and the member functions of complaints, grievances and appeals associated with timely care and service delivery quality.
- Directs and supports the use of evidence based guidelines, criteria and other clinical tools to reduce variation in clinical practice and to optimize clinical outcomes.
- Directs member grievance and complaint review process.
- Direct and implement reviews to meet legal and regulatory requirements for Hospital/Health Plan.
- Collaborates with medical staff to manage the medical staff functions including peer review and the practitioner performance review and oversight process.
- Directs and implements accreditation, licensing and regulatory activities and systems.
- Responsible for meeting all requirements, ensuring compliance in all applicable settings, and managing reliable processes for timely and accurate submissions.
- Directs and implements risk mitigation activities and corrective action plans.
- Identifies new legislations' effect on Hospital/Health Plan and implements programs that ensure alignment with new legislation.
- Directs implementation of reliable systems that support evidence based optimal care in both hospital and non-hospital setting.
- Directs and implements comprehensive infection control programs for surveillance prevention, data analysis and reporting, and control of infections across hospital, medical group, and environmental support departments.
- Develops and plans for patient safety and risk management programs and development of responsible reporting mechanisms.
- Ensures that the environment of care is safe, functional, supportive and effective both for the delivery of patient care and protection of the worker.
- Collaborates with medical staff to direct peer review, practitioner performance review and oversight process.
- Implements and directs a safe culture through responsible reporting of unusual events, human factors training, and design of systems for safe and reliable practices.
- Takes appropriate actions when errors occur and cause harm to members, patients staff and/or the organization.
- Directs, implement s and evaluates a comprehensive risk management plan for the facility to reduce or eliminate the potential for financial loss to reduce medical errors.
- Directs appropriate KFH/HP oversight to address for hospital/health plan risk issues.
- Collaborates with the ombudsman to ensure rapid resolution of patient concerns and grievances.
- Directs the significant event management program.
- Minimum five (5) years of combined experience in quality, risk management, patient safety, infection prevention/ accreditation/regulation, licensing, or clinical operations leadership in a healthcare setting.
- Minimum three (3) years of management experience in a healthcare setting.
- Bachelor's degree in health care administration, nursing, or public administration or related field required.
License, Certification, Registration
- Current RN licensed required.
- Uses registered nursing background as a substantial amount of scientific knowledge or technical skill for indirect patient care services that ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures.
- Experience designing, developing, implementing physician management programs.
- Demonstrated knowledge of governmental and other regulatory standards, requirements, and guidelines related to quality, risk and patient safety.
- Demonstrated subject matter expertise in performance improvement methodologies, ability and desire to integrate PI principles into work processes; demonstrated leadership, project management, facilitation, problem solving, and communication skills.
- Strong working knowledge of ongoing monitoring techniques (including criteria development and statistical analysis); medical care delivery in hospital and outpatient settings; total quality management principles, tools, and techniques.
- Effective communication, negotiation and leadership skills.
- Must be able to work in a Labor/Management Partnership.
- Demonstrated experience in direct patient care planning and clinical operations.
- CPHQ, HCAP, CPPS, CPHRM and/or project management certification in related field preferred.
- Experience in large integrated multi-faceted health care system with large medical group or in an academic medical setting.
- Current RN license in California preferred.
- Master's Degree preferred.