Director, Quality/Risk Management

South Central Texas

Texas Hill Country

Company Description:

• 140+ bed short term acuter care hospital

• Large multi-facility hospital system

• Faith based and mission driven

• Most preferred health care provider in South Texas

• Commitment to Excellence

Responsibilities:

• As a growing facility the Director will play a key role in our growth strategy and creating an atmosphere of safety and quality.

• The Director will collaborate with physicians and ancillary areas.

• Have strong regulatory requirements/survey knowledge and experience. 

• Experience with root cause analysis, Strategic in addressing physician relations, excellent and succinct communicator (written and verbal).

• Follow up on occurrences, risk issues in a timely manner. Experience with independent review boards such as the LeapFrog Group.

• The position will support 22 facility Directors

• There are approximately 1,100 Board Certified Hospital Physicians 

Job Function

• Develops, plans and implements policies and objectives of the facility for quality assessment, quality management, and performance improvement initiatives to enhance the quality of services. Analyzes healthcare processes and patient outcomes, develops outcome measures and monitors sensitive quality outcome indicators to identify areas for improvement. Evaluates the impact of improvement activities.

• Oversees sentinel event investigations and root cause analysis activities within the facility to reduce risks and increase patient safety.

• Reviews and analyzes facility occurrence reports to identify clinical risk issues. Facilitates investigation and follow-up on events with the appropriate managers/VPs.

• Initiates Probable Claims Report (PCR) as appropriate. Investigates, utilizing, record review, interviews and other methods in order to provide adequate information for the report.

• Facilitates the investigation and resolution of patient complaints and grievances. Initiates and/or reviews correspondence to patient/family following established timelines.

• Facilitates the implementation and completion of the elements of the annual HCI Premium Credit Program. Communicates the results of the quarterly Risk Metrics results to managers/ VPs and Senior Leaders. Facilitated development and communication of appropriate action plans for identified outliers.

Reporting Structure:

• 6 direct reports

• The Director will report to the hospital CNO

• Bachelor of Science in Nursing or related discipline. 

• 3-5 years clinical and managerial experience. 

• Quality Management practice, regulatory compliance, and TQM training and experience is preferred. 

• Experience in utilizing word processing, spreadsheets, clinical systems and databases.

Preferred Requirements:

• Master’s Degree

• Registered Nurse

Compensation:

• Market aggressive salary

• Performance bonus

• Full benefits 

• Relocation assistance

We look forward to receiving your application!

All your information will be kept confidential according to EEO guidelines.