Quality & Safety Improvement Consultant 3 - Clinical Quality Consulting

In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; assisting with the evaluation of evidence-based guidelines, principles, and/or programs related to area of work as well as supporting development and implementation efforts to reduce variation in clinical practice and optimize patient outcomes; assisting with the collection, analysis, reporting, and presentation of clinical data for a variety of users including for state, federal, and local agencies; helping to provide education on interpreting compliance methods when preparing for regulatory reviews, interpretation of regulatory requirements, and regional project goals; monitoring and reporting all occurrences which may lead to medical center liability and providing recommendations on mitigation plans; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and participating in the collaboration with applicable government agencies, regulatory agencies, and other organizations.

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Conducts data extraction, analyses, and presentations to support quality improvement efforts by\: conducting descriptive and inferential statistics for quality improvement evaluations; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; preparing quality improvement metric reports at the individual level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and identifying and documenting trends, potential errors, and other analysis for further review and reports them to the supervisor.
• Supports quality improvement and improvement risk management efforts by\: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys; ensuring process improvements are compliant with established internal and external regulation requirements; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to near misses and good catches in order to identify areas of improvement; and assisting with escalating high-risk issues and trends to appropriate entity for resolutions.
• Develops and utilizes quality improvement performance metrics by\: implementing and developing performance metrics, standards, and methods to establish improvement success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.
• Facilitates the development of quality improvement initiatives by\: implementing methods and tools to develop stakeholders capabilities for process improvements; applying data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing milestones, detailed workplans, and documentation practices.
• Serves as the subject matter expert for quality improvement processes and regulations within assigned area by\: learning current internal policies and external regulations; participating on committees, projects to provide guidance on the enforcement, development of policies or procedures of regulations and auditing processes; leveraging collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; and preparing materials for educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage.
• Delivers stakeholder development and quality performance review efforts by\: coordinating and conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering training and educational programs related to process improvement for quality improvement programs for stakeholders.

In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; assisting with the evaluation of evidence-based guidelines, principles, and/or programs related to area of work as well as supporting development and implementation efforts to reduce variation in clinical practice and optimize patient outcomes; assisting with the collection, analysis, reporting, and presentation of clinical data for a variety of users including for state, federal, and local agencies; helping to provide education on interpreting compliance methods when preparing for regulatory reviews, interpretation of regulatory requirements, and regional project goals; monitoring and reporting all occurrences which may lead to medical center liability and providing recommendations on mitigation plans; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and participating in the collaboration with applicable government agencies, regulatory agencies, and other organizations.

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Conducts data extraction, analyses, and presentations to support quality improvement efforts by\: conducting descriptive and inferential statistics for quality improvement evaluations; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; preparing quality improvement metric reports at the individual level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and identifying and documenting trends, potential errors, and other analysis for further review and reports them to the supervisor.
• Supports quality improvement and improvement risk management efforts by\: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys; ensuring process improvements are compliant with established internal and external regulation requirements; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to near misses and good catches in order to identify areas of improvement; and assisting with escalating high-risk issues and trends to appropriate entity for resolutions.
• Develops and utilizes quality improvement performance metrics by\: implementing and developing performance metrics, standards, and methods to establish improvement success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.
• Facilitates the development of quality improvement initiatives by\: implementing methods and tools to develop stakeholders capabilities for process improvements; applying data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing milestones, detailed workplans, and documentation practices.
• Serves as the subject matter expert for quality improvement processes and regulations within assigned area by\: learning current internal policies and external regulations; participating on committees, projects to provide guidance on the enforcement, development of policies or procedures of regulations and auditing processes; leveraging collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; and preparing materials for educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage.
• Delivers stakeholder development and quality performance review efforts by\: coordinating and conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering training and educational programs related to process improvement for quality improvement programs for stakeholders.

• Minimum one (1) year of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum two (2) years of experience in quality, performance improvement, customer service, or a related field OR Minimum five (5) years of experience in heath care quality assurance/improvement or a directly related field.

• Registered Professional Nurse License (Georgia)

• Minimum one (1) year of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum two (2) years of experience in quality, performance improvement, customer service, or a related field OR Minimum five (5) years of experience in heath care quality assurance/improvement or a directly related field.

• Registered Professional Nurse License (Georgia)

• Health care clinical license from the practicing/applicable state (e.g., Registered Nurse (RN), Registered Pharmacist (RPh), Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker).
• Certified Professional in Healthcare Quality (CPHQ).

• Health care clinical license from the practicing/applicable state (e.g., Registered Nurse (RN), Registered Pharmacist (RPh), Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker).
• Certified Professional in Healthcare Quality (CPHQ).

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