Overview: This position is responsible for the administrative and quality management, planning, development, implementation and evaluation/improvement of clinical care services/programs. He/she will ensure patient care staff provide high quality, accessible, cost effective care & patient-focused services; implements & maintains clinical & patient care practice standards & staff development. This position will also perform medical records data review and analysis related to quality of care issues, project development and coordination, project reports, and ongoing reassessments to sustain improvements in quality measures and service outcomes to meet the demands of regulations set forth by California Department of Aging and California Department of Public Health and programs. This position will also identify opportunities for improvement and implement processes that support evidence-based best practices as well as applying quality improvement techniques. He/she will be asked to support accreditation activities such as Joint Commission and HP (Facility Site Review and NCQA standards) surveys and will be responsible to conduct Level of Care review for ADHC medical necessity criteria. Responsibilities: Manages outpatient programs in an ADHC setting services and operations and is responsible for the delivery of nursing services and outpatient care which are integrated w/ business plans and meet or exceed cost, quality, clinical and utilization standards and performance measures. Achieves integrated services across the continuum of care & manages and ensures continuous improvement of all clinical practices, services and operations by designing and implementing systems, processes and methods to evaluate and improve patient care. Ensures patient care staff provide the highest quality of care and are in compliance w/ the Nurse Practice Act, ADHC standards, JCAHO, federal, state and local requirements. Plans for and designs a quality management strategy for ADHC and a written plan that incorporates performance, outcomes and clinical process improvement. Utilizes quality improvement tools to collect, analyze, interpret, report and display data that improve processes and patient care. Collaborates w/ Regional Medical Director of Senior Care Services, community-based physicians, nursing and other health care providers in establishing, implementing and maintaining patient centered care and quality service standards to meet members’ and internal clients’ expectations. Acts as a patient advocate resolving patient care issues. Develops, implements and monitors departmental policies and procedures which support the organization’s goals and business objectives and ensures they are met. Develops processes to orient, train and maintain the competency of all ADHC Nursing staff. Develop processes and conducts focused case reviews/audits identified through event reports, staff referrals quality assurances and customer concerns in association with quality indicators and measures. Assist in collecting, monitoring, and reporting of ADHC quality chart reviews by site by month and provide quarterly analysis. Support the development of QI, project tools, and policies and procedures with system wide implication. Assist in establishing best practices and organizational wide key performance indicators as a member of various QI and operations committees to ensure strategic alignment and effectiveness. Work with sponsors, regulatory agencies, internal and external stakeholders, to support quality initiative deployment, issues resolution, change manage with meaningful data driven information. Liaison with corporate compliance and accreditation teams. Collaborate with Senior Care Operations Trainer to develop, implement and evaluate care plan documentation training modules for all ADHC disciplines. Performs other related duties as assigned. Qualifications: Bachelors degree in Nursing or Health Services required. Masters degree in Health Services or Business Administration or Management preferred. Current CA license as Registered Nurse required. Minimum of 4 years experience in clinical care management or other related clinical management experience required. Current CPR/First Aid certificate required. Minimum of 3 years of experience in level of care review or quality assurance review required. Skilled nursing assisted living, ADHC, IHSS or PACE field preferred. Certification as a Certified Professional in Health Care Quality (CPHQ) preferred. Bilingual English/Spanish preferred.
Associated topics: ambulatory, coronary, hospice, intensive, intensive care, intensive care unit, maternal, neonatal, nurse, registed