National Association of Latino Healthcare Executives · 5 hours ago
Quality & Safety Oversight Specialist V, Clinical Quality Oversight
Hyattsville, MD
Full-time
Onsite
Senior Level
5+ years expThe National Association of Latino Healthcare Executives is focused on enhancing healthcare quality and safety. They are seeking a Quality & Safety Oversight Specialist V to provide oversight of systems ensuring quality care and services for members and patients, while also leading the peer review process and managing quality improvement initiatives.
HealthcareHospitalHealth CareMedical
Responsibilities
Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit. Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams
Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals. Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others
Serves as the subject matter expert for clinical quality improvement processes and regulations practitioners, Quality Specialists, department managers, and peers, projects/committees, and internal stakeholders by: providing consultation on the interpretation and interaction of current policies, and how they interact with the current climate, and potential changes to regulations and legislation; serving as a technical advisor on committees, projects to drive discussions on drawing guidelines on the enforcement, development of policies or procedures of regulations and auditing processes; maintaining collaborative, results oriented partnerships with practitioners and/or staff across clinical and administrative roles to ensure compliance with regulations and improve patient safety, reporting accuracy, and health outcomes and provides insight to the regulation climate; developing educational programs to raise awareness for current and changes in regulation requirement, internal concerns, and system/database usage; and anticipating issues, weighing practical and technical considerations in addressing issues, and coordinating with the appropriate stakeholders to develop resolutions
Develops the quality of care complaints and the review process by: coordinating grievance meetings, cases, reviews, referrals, or other mechanisms by collaborating with the ombudsman and external regulatory services; responding to and directing the preparations of all documentation, records, and information requested for specific patient case reviews; ensuring consistent follow through on quality of care concerns and analyzing and managing the process flow of investigations and claims for potential errors, red flags, and areas of improvement; and monitoring critical quality improvement metrics, cases, quality care incidents, and near misses according to established protocols on an ongoing basis
Develops risk management efforts by: researching corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys; serving as a subject matter expert for internal and external policies, regulations, scientific research, and legislation related to quality improvement; conducting complex 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 evaluate newly internalized processes and programs; and exercising independent judgment to escalate high-risk issues and trends to appropriate entity for resolutions
Provides consultation for the development of new clinical quality improvement programs by: consulting with teams and departments to develop guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, analyzing program performance, and peer/department review groups by challenging groups to provide creative solutions; leveraging a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and researching and investigating innovative opportunities to develop KPs capacity as a learning organization, increasing capacity in areas such as video ethnography, patient-reported outcomes, and harvesting of best practices
Develops and implements systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs by: ensuring the quality improvement monitoring agenda for assigned departments includes all aspects of data management and analysis of trends and patterns of practice; conducting descriptive inferential, reliability, and confidence intervals statistical analysis for routine and special projects related to quality improvement evaluations; developing the procedures for gathering and entering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and analyzing and presenting reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) into specified formats for internal stakeholders and working with departments to develop action plans
Develops the process for regulatory audits and survey efforts by: serving as a liaison between external evaluators, vendors, and departments for onsite visits and evaluations; delivering ad hoc and complex requested audit documentation, information, reports, and tools throughout the auditing process; assessing the workflow of completing auditing surveys to identify gaps in completion and reporting; and conducting routine mock audits and surveys within departments to ensure auditing and survey preparedness
Seeks and addresses feedback from the evaluation of the cost effectiveness, practicality, and appropriateness of medical care given to patients by: creating the reports to be used in complex case reviews with senior leaders and practitioners; analyzing current standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care and escalates concerns or improvements to senior leaders; analyzing current patient treatment plans to ensure patient needs are met in a timely manner and escalates issues to senior leaders; leading discussions with practitioners, staff, and patients to identify population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others, and providing recommendations to senior leaders; and analyzing previous patient cases to identify areas of improvement for length of stay, type of treatment, and time of treatment, and reporting recommendations to the Manager
Qualification
Required
Partnering with the Board of Directors in providing oversight of systems designed to monitor and ensure the quality care and services are provided at a comparable level to all members and patients across the continuum of care
Serving as a point of escalation for complex issues in quality improvement systems
Proactively identifying and communicating issues related to the organization meeting the standards established by regulatory agencies and accreditation organizations and meeting public expectations
Ensuring the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners
Monitoring systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education
Reviewing and approving medical staff or provider staff Bylaws, Rules and Regulations and amendments
Managing the oversight of systems of all contracted entities including but not limited to the Permanente Medical Groups
Leading the peer review process, committees, and forums through evaluating and integrating direct information on hospital or health system performance
Developing comprehensive feedback and refining and communicating a strategic development plan to address needs and solve problems
Promoting learning in others by communicating information and providing advice to drive projects forward
Building relationships with cross-functional stakeholders
Listening, responding to, seeking, and addressing performance feedback
Providing actionable feedback to others, including upward feedback to leadership and mentoring junior team members
Practicing self-leadership; creating and executing plans to capitalize on strengths and improve opportunity areas
Influencing team members within assigned team or unit
Adapting to competing demands and new responsibilities
Conducting or overseeing business-specific projects by applying deep expertise in subject area
Promoting adherence to all procedures and policies
Partnering internally and externally to make effective business decisions
Determining and carrying out processes and methodologies
Solving complex problems and escalating high-priority issues or risks, as appropriate
Monitoring progress and results
Developing work plans to meet business priorities and deadlines
Coordinating and delegating resources to accomplish organizational goals
Recognizing and capitalizing on improvement opportunities
Evaluating recommendations made and influencing the completion of project tasks by others
Serving as the subject matter expert for clinical quality improvement processes and regulations
Providing consultation on the interpretation and interaction of current policies
Maintaining collaborative, results-oriented partnerships with practitioners and/or staff across clinical and administrative roles
Developing educational programs to raise awareness for current and changes in regulation requirement
Anticipating issues, weighing practical and technical considerations in addressing issues
Coordinating with the appropriate stakeholders to develop resolutions
Developing the quality of care complaints and the review process
Coordinating grievance meetings, cases, reviews, referrals, or other mechanisms
Responding to and directing the preparations of all documentation, records, and information requested for specific patient case reviews
Ensuring consistent follow through on quality of care concerns
Analyzing and managing the process flow of investigations and claims for potential errors, red flags, and areas of improvement
Monitoring critical quality improvement metrics, cases, quality care incidents, and near misses according to established protocols on an ongoing basis
Developing risk management efforts by researching corrective action plans for areas of improvement
Serving as a subject matter expert for internal and external policies, regulations, scientific research, and legislation related to quality improvement
Conducting complex root cause analysis, failure mode and effect analysis, and other assessments in response to significant events
Exercising independent judgment to escalate high-risk issues and trends to appropriate entity for resolutions
Providing consultation for the development of new clinical quality improvement programs
Consulting with teams and departments to develop guidelines, metrics, and operational definitions of quality improvement
Leveraging a variety of health concepts, regulatory requirements, and change management principles to develop programs
Researching and investigating innovative opportunities to develop KPs capacity as a learning organization
Developing and implementing systems, procedures, and forms to improve data management programs
Utilizing data to monitor and improve performance of all worker and patient safety programs
Ensuring the quality improvement monitoring agenda for assigned departments includes all aspects of data management and analysis of trends and patterns of practice
Conducting descriptive inferential, reliability, and confidence intervals statistical analysis for routine and special projects
Developing the procedures for gathering and entering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources
Analyzing and presenting reports into specified formats for internal stakeholders
Working with departments to develop action plans
Developing the process for regulatory audits and survey efforts
Serving as a liaison between external evaluators, vendors, and departments for onsite visits and evaluations
Delivering ad hoc and complex requested audit documentation, information, reports, and tools throughout the auditing process
Assessing the workflow of completing auditing surveys to identify gaps in completion and reporting
Conducting routine mock audits and surveys within departments to ensure auditing and survey preparedness
Seeking and addressing feedback from the evaluation of the cost effectiveness, practicality, and appropriateness of medical care given to patients
Creating reports to be used in complex case reviews with senior leaders and practitioners
Analyzing current standard operating procedures for treatment for specific medical codes
Leading discussions with practitioners, staff, and patients to identify population health needs
Providing recommendations to senior leaders
Analyzing previous patient cases to identify areas of improvement for length of stay, type of treatment, and time of treatment
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
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