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Area Director of Quality

Area Director of Quality

ClearSky HealthAvondale, AZ, US
30+ days ago
Job type
  • Full-time
Job description

Area Director Of Quality

The Area Director Of Quality provides clinical leadership for the following areas : Medical Staff Services, Regulatory Compliance, Risk Management, and Quality Management / Improvement. This position must integrate company values into daily practice.

Essential Functions

  • Facilitates compliance for the Hospital related to CMS, The Joint Commission, and State / Federal regulations. Completes audits to identify ongoing compliance.
  • Makes Hospital visits at least quarterly, or as needed, to assigned hospitals to perform onsite analysis of ongoing performance of quality program.
  • Prepares Medical Staff, hospital and hospital staff for survey activities by regulatory and accrediting agencies. Drafts survey responses to regulatory and accreditation agencies.
  • Collaborates with the medical staff regarding functions related to medical staff privileging and credentialing, performance improvement measurements, professional practice evaluation development and reviews, and aggregation by practitioners.
  • Facilitates the hospital performance improvement program through the collaboration with other hospital leaders. Provides guidance regarding measurements, data collection, analysis, conclusions, and process improvement.
  • Implements and manages clinical risk management functions including incident reporting, investigational follow up, grievances, root cause analysis, provides notices of potential claims, and litigation management in conjunction with senior leadership.
  • Educates Medical Staff and hospital employees during initial orientation, re-orientation, and as education in area of expertise is indicated.
  • Ensures submission of data to internal and external databases, as required by accreditation and regulatory agencies, is submitted timely and accurately.
  • Provides an environment conducive to safety for patients, visitors, and staff.
  • Assesses the risks for safety and implements appropriate precautions.
  • Shares patient satisfaction data with leadership / staff monthly and coordinates improvement. Identifies opportunities for improvement and coordinates the organizational efforts to improve patient satisfaction.
  • Performs other duties as assigned to support overall effectiveness of the organization.

Minimum Job Requirements Minimum Education & Experience

  • Bachelor's Degree in a biological science required
  • Minimum four years clinical experience preferred
  • Two years in clinical compliance role preferred
  • Relevant education / experience may be substituted for one another in accordance with Hospital requirements
  • Required Licenses, Certifications, and / or Documentation

  • Clinical licensure preferred
  • Required Knowledge, Skills, and Abilities

  • Knowledge of current Federal, State and Joint Commission standards and hospital specific rules and regulations.
  • Knowledge of current infection prevention and control processes, including CDC and OSHA standards.
  • Demonstrates general computer skills including data entry, word processing, email, and records management.
  • Demonstrates critical thinking skills.
  • Effective organizational and time management skills.
  • Effective written and verbal communication skills.
  • Ability to prioritize, meet deadlines, and complete complex tasks.
  • Ability to maintain quality, safety, and / or infection prevention standards.
  • Ability to work independently.
  • Ability to maintain proper levels of confidentiality.
  • Ability to work closely and professionally with others at all levels of the organization.
  • Physical Requirements Over the Course of a Shift

  • A significant amount of sitting.
  • Lifting / exerting of up to 25 lbs.
  • Sufficient manual dexterity to operate equipment and computer keyboard.
  • Close vision and the ability to adjust focus.
  • Ability to hear overhead pages.
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    Director Of Quality • Avondale, AZ, US