QI Manager
Apply NowCompany: Kedren Community Health And Acute Psychiatric Hospital
Location: Los Angeles, CA 90011
Description:
QUALITY MANAGEMENT PROGRAM
The primary purpose of the hospital's QM program is to promote excellence in patient care through continuous objective assessment of important aspects of care/service and the resolution of identified problems. An integral component of the QM program is to establish a systematic approach to addressing quality assessment and process improvement at Kedren. It is the goal of the QM Program to enhance the patients' health and safety, improve the members' perception of care, achieve optimal outcomes, enhance staff morale and improve organizational efficiency and effectiveness.
QUALITY IMPROVEMENT MANAGER DUTIES AND EXPECTATIONS
The goal of the Quality Improvement Manager (QIM) is to develop, implement, and oversee initiatives aimed at enhancing patient care, safety, and satisfaction for all clients and providers. Responsibilities will encompass analyzing data, identifying improvement areas, and ensuring compliance with regulatory standards set forth by the Department of Mental Health (DMH), Centers for Medicare & Medicaid Services (CMS), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This multifaceted role demands expertise in data analysis, utilizing mathematical and statistical applications to support the creation, implementation, and adjustment of financial goals. This individual will closely monitor physician and Advanced Practice Providers (APP) productivity, track quality indicators, and ensure adherence to relevant regulations. Real-time tracking of physician productivity goals, analysis of influencing factors, and monitoring quality indicators for inpatient and outpatient units will be integral to the role. Familiarity with behavioral health biometrics and EMR systems, and active participation in quality improvement research, are also key components. Collaboration with the CMO is fundamental to achieving our overarching goal of delivering comprehensive, integrated, and responsive care and services aligned with Kedren's standards.
The Quality Improvement Manager will ensure the oversight, implementation, direction, and adherence to Kedren's objectives, scope and content of quality management activities, which include:
1.Continuous Quality Improvement
To educate all providers, staff and administrators about the philosophy, procedures and practices of continuous quality improvement (CQI) at Kedren Health and its importance within the missions of standards of care of the participating clinics.
To implement the Patient Centered Care Home Model as a process to improve clinical outcomes.
To develop interdisciplinary teams who apply the Plan- Do-Study-Act cycles to determine effective improvement interventions towards target goals.
To collect baseline data if possible to define pre-intervention performance and post- intervention results.
To identify and evaluate specific clinical or service issues, using standardized indicators, benchmarks, and data collection to determine and implement a quality improvement plan. To develop monitoring tools (if applicable) and reassess the issues on a continuous, ongoing and meaningful basis.
To incorporate primary care, specialty care, behavioral health and hospital/institutional referral services in the CQI process. To evaluate appropriate utilization of services.
2.Utilization Management
To appropriately evaluate and coordinate a patient's need for ancillary services, specialty services and referrals, assuring appropriate utilization based on practice guidelines and clinical judgment.
To evaluate systems for tracking appropriate follow up of abnormal diagnostic studies and the use of preventive health measures. To incorporate case management guidelines in order to optimize utilization of the services and decrease barriers to care.
3.Risk Management
To develop a comprehensive data collection system through medical information systems, review of medical records and client complaints to assure that the medical services are provided in an acceptable, efficient and sensitive manner.
To create a member advisory committee to give feedback on clinic services and promotes communication between providers and members.
To evaluate case management and tracking of patient follow up for preventive services, abnormal lab/procedure results, adverse outcomes and specific diseases or service indicators in order to direct the Kedren Health towards a specific review of clinic or provider practice.
To establish and maintain basic elements of risk management (such as documentation, charting procedures, medical records, case management, communication systems, clinical supervision and maintenance of confidentiality) by means of, but not limited to:
a.Audits
To address specific aspects of the patients (members)' interface with the clinics, including access, service availability, the referral process, efficiency, communication and continuity. To adopt standard templates for internal evaluation of these service elements.
To collect and analyze data to compare performance to standards, implement interventions to improve performance and evaluate effectiveness of interventions.
To ensure the availability of appropriate primary care and specialty providers and to consider any unique needs and preferences of the patients (members) in arranging appointments and facilitating access.
To monitor compliance with access standards.
Preventive Care Appointments 30 Days
Routine Appointments 14 Days
Urgent Care Appointments 24 hours
Emergency Care Immediate
b.Patient Satisfaction
To collect and review survey data from patients (members) to be aware of patient-perceived concerns and to incorporate specific trends of problems into other review processes that are part of the QMP (CQI, Risk Management, Peer Review, and Utilization Management).
c.Peer Review
To review medical records using a Kedren Health standardized tool in order to identify concerns in the provision of medical care, utilization, or documentation by clinic staff.
To establish inter-provider consistency and adherence to baseline uniform standards in the medical records and in the care of patients (members). To use disciplinary action when needed to maintain standards of care and service.
d.Provider Retention and Member Retention
To collect and review input from Kedren Health providers to be aware of any concerns raised by clinical staff. To respond appropriately to such information and ultimately maintain provider satisfaction.
To collect and review input from Kedren Health members to be aware of any concerns raised by membership. To respond appropriately to such information and ultimately maintain member satisfaction.
e.Client Complaints
To develop and implement standardized forms and procedures for the identification and resolution of complaints by internal and external clients (patients, providers, clinic staff, and specialists).
To identify problems and take corrective action, as applicable, to improve the quality of care provided by clinical staff.
f.Credentialing/Re-credentialing
To ensure that all licensed or certified health care practitioners are licensed, registered or certified by the State of California in accordance with credentialing requirements.
To give final approval or denial for providers credentialing or re-credentialing whose qualifications have been verified.
g.Clinical Practice Guidelines
To adopt and maintain optimal care to achieve best practices. To utilize such guidelines as a tool in reviewing practice patterns, treatment plans, referrals, and establishing an approach to reduce provider variability thus standardizing the quality of care.
h.Policies and Procedures
To ensure the delivery of high-quality patient care and service, including preventive medicine, in a safe and cost-effective manner using consistent and comprehensive internal guidelines.
To monitor the effectiveness and compliance with such policies and procedures through other Kedren Health QMP activities.
To develop standardized physician assistant supervisor contracts and nurse
practitioner process-oriented protocols that remain timely, comply with state regulations and support a high standard of care.
i. Patient Education
Assist clinics in adopting and maintaining culturally and linguistically appropriate patient education materials.
j. Emergency Health Care
The Director of Quality Management is responsible for the overall direction, coordination and implementation of the QI Program for California Department of Healthcare Services licensed acute psychiatric hospital. The primary role will be the assurance of the organization's compliance with care standards and quality key performance indicators. This will include the collection, management and analysis of quality data and the preparation of quality reports. Practical knowledge of tools and techniques of Continuous Quality Improvement (CQI), including analysis and interpretation of data using computer-based electronic health records data collection systems is essential. The Director of Quality Management must be familiar with the processes associated with attainment and maintenance of JACHO accreditation. The Director of Quality Management will participate in and assist in preparation for all clinical audits and surveys at the local, state, and federal level inclusive of those such associated with various health plans, and may interface with personnel from these regulatory bodies. Furthermore, the Director of Quality Management will assist in the provision of data needed for grant attainment and those associated with hospital funding submissions. The Director of Quality Management may assist the Compliance officer or other QI staff with necessary follow-up as related to Root-Cause-Analysis (RCA) investigations and will assist in the devising, implementation, and monitoring of corrective action plans, as applicable.
MINIMUM QUALIFICATIONS REQUIRED FOR THIS POSITION:
Bachelor or Master in Nursing, Quality Management, Social Work, Healthcare Administration or related field preferred, yet individuals with strong related experience in leading a quality improvement program may be considered
Minimum 2-3 years of progressive experience in Quality Improvement in a healthcare facility, preferably with a federally qualified health center doing business in California.
Project management skills
Must demonstrate integrity, sound judgment, leadership skills, and strong interpersonal skills.
Must be able to approach staff about quality issues with tact and diplomacy.
Experience working with disadvantaged populations helpful and knowledge of health disparities highly desired.
Excellent oral and written communication skills needed, strong organizational ability required.
Outstanding skills in data collection, analysis, and presentation.
Experience in the use of spreadsheets (e.g. Excel) for QI-related data management and display
Current Basic Life Support (BLS) certification for Healthcare Providers
Current CPR Certification
Project management, time management, team-building, analytical, and facilitation skills.
The primary purpose of the hospital's QM program is to promote excellence in patient care through continuous objective assessment of important aspects of care/service and the resolution of identified problems. An integral component of the QM program is to establish a systematic approach to addressing quality assessment and process improvement at Kedren. It is the goal of the QM Program to enhance the patients' health and safety, improve the members' perception of care, achieve optimal outcomes, enhance staff morale and improve organizational efficiency and effectiveness.
QUALITY IMPROVEMENT MANAGER DUTIES AND EXPECTATIONS
The goal of the Quality Improvement Manager (QIM) is to develop, implement, and oversee initiatives aimed at enhancing patient care, safety, and satisfaction for all clients and providers. Responsibilities will encompass analyzing data, identifying improvement areas, and ensuring compliance with regulatory standards set forth by the Department of Mental Health (DMH), Centers for Medicare & Medicaid Services (CMS), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This multifaceted role demands expertise in data analysis, utilizing mathematical and statistical applications to support the creation, implementation, and adjustment of financial goals. This individual will closely monitor physician and Advanced Practice Providers (APP) productivity, track quality indicators, and ensure adherence to relevant regulations. Real-time tracking of physician productivity goals, analysis of influencing factors, and monitoring quality indicators for inpatient and outpatient units will be integral to the role. Familiarity with behavioral health biometrics and EMR systems, and active participation in quality improvement research, are also key components. Collaboration with the CMO is fundamental to achieving our overarching goal of delivering comprehensive, integrated, and responsive care and services aligned with Kedren's standards.
The Quality Improvement Manager will ensure the oversight, implementation, direction, and adherence to Kedren's objectives, scope and content of quality management activities, which include:
1.Continuous Quality Improvement
To educate all providers, staff and administrators about the philosophy, procedures and practices of continuous quality improvement (CQI) at Kedren Health and its importance within the missions of standards of care of the participating clinics.
To implement the Patient Centered Care Home Model as a process to improve clinical outcomes.
To develop interdisciplinary teams who apply the Plan- Do-Study-Act cycles to determine effective improvement interventions towards target goals.
To collect baseline data if possible to define pre-intervention performance and post- intervention results.
To identify and evaluate specific clinical or service issues, using standardized indicators, benchmarks, and data collection to determine and implement a quality improvement plan. To develop monitoring tools (if applicable) and reassess the issues on a continuous, ongoing and meaningful basis.
To incorporate primary care, specialty care, behavioral health and hospital/institutional referral services in the CQI process. To evaluate appropriate utilization of services.
2.Utilization Management
To appropriately evaluate and coordinate a patient's need for ancillary services, specialty services and referrals, assuring appropriate utilization based on practice guidelines and clinical judgment.
To evaluate systems for tracking appropriate follow up of abnormal diagnostic studies and the use of preventive health measures. To incorporate case management guidelines in order to optimize utilization of the services and decrease barriers to care.
3.Risk Management
To develop a comprehensive data collection system through medical information systems, review of medical records and client complaints to assure that the medical services are provided in an acceptable, efficient and sensitive manner.
To create a member advisory committee to give feedback on clinic services and promotes communication between providers and members.
To evaluate case management and tracking of patient follow up for preventive services, abnormal lab/procedure results, adverse outcomes and specific diseases or service indicators in order to direct the Kedren Health towards a specific review of clinic or provider practice.
To establish and maintain basic elements of risk management (such as documentation, charting procedures, medical records, case management, communication systems, clinical supervision and maintenance of confidentiality) by means of, but not limited to:
a.Audits
To address specific aspects of the patients (members)' interface with the clinics, including access, service availability, the referral process, efficiency, communication and continuity. To adopt standard templates for internal evaluation of these service elements.
To collect and analyze data to compare performance to standards, implement interventions to improve performance and evaluate effectiveness of interventions.
To ensure the availability of appropriate primary care and specialty providers and to consider any unique needs and preferences of the patients (members) in arranging appointments and facilitating access.
To monitor compliance with access standards.
Preventive Care Appointments 30 Days
Routine Appointments 14 Days
Urgent Care Appointments 24 hours
Emergency Care Immediate
b.Patient Satisfaction
To collect and review survey data from patients (members) to be aware of patient-perceived concerns and to incorporate specific trends of problems into other review processes that are part of the QMP (CQI, Risk Management, Peer Review, and Utilization Management).
c.Peer Review
To review medical records using a Kedren Health standardized tool in order to identify concerns in the provision of medical care, utilization, or documentation by clinic staff.
To establish inter-provider consistency and adherence to baseline uniform standards in the medical records and in the care of patients (members). To use disciplinary action when needed to maintain standards of care and service.
d.Provider Retention and Member Retention
To collect and review input from Kedren Health providers to be aware of any concerns raised by clinical staff. To respond appropriately to such information and ultimately maintain provider satisfaction.
To collect and review input from Kedren Health members to be aware of any concerns raised by membership. To respond appropriately to such information and ultimately maintain member satisfaction.
e.Client Complaints
To develop and implement standardized forms and procedures for the identification and resolution of complaints by internal and external clients (patients, providers, clinic staff, and specialists).
To identify problems and take corrective action, as applicable, to improve the quality of care provided by clinical staff.
f.Credentialing/Re-credentialing
To ensure that all licensed or certified health care practitioners are licensed, registered or certified by the State of California in accordance with credentialing requirements.
To give final approval or denial for providers credentialing or re-credentialing whose qualifications have been verified.
g.Clinical Practice Guidelines
To adopt and maintain optimal care to achieve best practices. To utilize such guidelines as a tool in reviewing practice patterns, treatment plans, referrals, and establishing an approach to reduce provider variability thus standardizing the quality of care.
h.Policies and Procedures
To ensure the delivery of high-quality patient care and service, including preventive medicine, in a safe and cost-effective manner using consistent and comprehensive internal guidelines.
To monitor the effectiveness and compliance with such policies and procedures through other Kedren Health QMP activities.
To develop standardized physician assistant supervisor contracts and nurse
practitioner process-oriented protocols that remain timely, comply with state regulations and support a high standard of care.
i. Patient Education
Assist clinics in adopting and maintaining culturally and linguistically appropriate patient education materials.
j. Emergency Health Care
The Director of Quality Management is responsible for the overall direction, coordination and implementation of the QI Program for California Department of Healthcare Services licensed acute psychiatric hospital. The primary role will be the assurance of the organization's compliance with care standards and quality key performance indicators. This will include the collection, management and analysis of quality data and the preparation of quality reports. Practical knowledge of tools and techniques of Continuous Quality Improvement (CQI), including analysis and interpretation of data using computer-based electronic health records data collection systems is essential. The Director of Quality Management must be familiar with the processes associated with attainment and maintenance of JACHO accreditation. The Director of Quality Management will participate in and assist in preparation for all clinical audits and surveys at the local, state, and federal level inclusive of those such associated with various health plans, and may interface with personnel from these regulatory bodies. Furthermore, the Director of Quality Management will assist in the provision of data needed for grant attainment and those associated with hospital funding submissions. The Director of Quality Management may assist the Compliance officer or other QI staff with necessary follow-up as related to Root-Cause-Analysis (RCA) investigations and will assist in the devising, implementation, and monitoring of corrective action plans, as applicable.
MINIMUM QUALIFICATIONS REQUIRED FOR THIS POSITION:
Bachelor or Master in Nursing, Quality Management, Social Work, Healthcare Administration or related field preferred, yet individuals with strong related experience in leading a quality improvement program may be considered
Minimum 2-3 years of progressive experience in Quality Improvement in a healthcare facility, preferably with a federally qualified health center doing business in California.
Project management skills
Must demonstrate integrity, sound judgment, leadership skills, and strong interpersonal skills.
Must be able to approach staff about quality issues with tact and diplomacy.
Experience working with disadvantaged populations helpful and knowledge of health disparities highly desired.
Excellent oral and written communication skills needed, strong organizational ability required.
Outstanding skills in data collection, analysis, and presentation.
Experience in the use of spreadsheets (e.g. Excel) for QI-related data management and display
Current Basic Life Support (BLS) certification for Healthcare Providers
Current CPR Certification
Project management, time management, team-building, analytical, and facilitation skills.