Clinical Quality Compliance Consultant

American Addiction Centers • Winston-Salem, NC

1d • Onsite

About The Position

This full-time position is responsible for facilitating compliance with evolving quality measures, including TJC Oryx Reporting of Core Measures, Leapfrog, CMS's National Hospital Quality Measures, and National Quality Forum quality measurement and reporting requirements, as well as other benchmarking reporting requirements. The role involves developing measurement and improvement strategies, overseeing clinical review for data accuracy, investigating quality concerns, and providing findings and recommendations to leadership. The consultant will also work to strengthen clinical documentation and coding, monitor hospital-acquired conditions, manage quality and safety projects, and establish collaborative relationships across the medical center. Keeping current with data abstraction specifications and emerging trends in hospital quality is essential.

Requirements

• Graduation from an accredited School of Nursing with a bachelor's degree in healthcare or a business-related field; or, ten years nursing experience in an academic medical center and three years of clinical quality review related work experience required.
• Current license to practice as a Registered Nurse (RN) in the State of applicable state.
• Superior organizational and interpersonal skills with ability to work independently.
• Knowledge of state and federal regulations specific to external reporting mandates.
• Excellent communication and follow up accompanied by the ability to analyze and present data in a way to influence and change behavior.
• Excellent creativity and enthusiasm for developing and implementing new programs.
• High degree of professionalism, discretion, and confidentiality.
• Comfortable interacting with a vast array of administrative and clinical staff, ranging from the Chief Medical Officer and department Chairs, to frontline care providers.
• Experience with performance improvement methods, including statistical concepts and applications.
• Strong project management skills with experience in planning, facilitating, and organizing teams.
• Strong computer skills (Word, Excel, and PowerPoint applications), preferably 2010 version.
• Ability to be flexible accommodating clinicians schedules when early or late meetings are necessary.

Nice To Haves

• Master's degree preferred.
• Three years' experience in quality measurement and/or improvement, patient safety, or health science research preferred.
• Experience working in a complex health care organization (e.g., academic medical center) preferred.
• Certified Professional in Healthcare Quality preferred.

Responsibilities

• Facilitates compliance with evolving quality measures including, TJC Oryx Reporting of Core Measures, Leapfrog, CMSs National Hospital Quality Measures, and National Quality Forum quality measurement and reporting requirements, and other benchmarking reporting requirements.
• Develops both measurement and improvement strategies for assigned performance measures and programs.
• Oversees clinical review in area of responsibility to ensure complete and accurate data collection and data entry for assigned performance measures and programs/projects within established timeframes.
• Works with Quality Department leadership to investigate quality concerns or issues arising from external payer reviews, external clinical benchmarking efforts (NSQIP, UHC, Leapfrog, TJC, etc.), or tracking of surveillance of major outcome measures (e.g., mortality, readmission, and reoperation rates).
• Provides concise clinical quality review findings, develop recommendations for corrective actions and/or improvement opportunities to leadership as warranted, and track the impact of implemented changes.
• Works with assigned team and quality leaders across the medical center to strengthen clinical documentation and coding to ensure that all DRG related and CPT related coding accurately reflects the patient's complexity and clinical course.
• Monitors review process for all hospital acquired conditions and publicly reported conditions to ensure accuracy of information provided to regulatory reporting agencies.
• Works with Quality Assessment Director and Performance Excellence division leaders to manage specified quality and safety related projects as determined by leadership, including developing project timelines, agendas, reports, and presentations to various audiences as appropriate.
• Establishes effective and collaborative working relationships with members of the hospital community, clinical departments, administrative departments, and quality and safety staff across Wake Forest Baptist Health.
• Keeps current with data abstraction specifications, emerging trends in hospital quality and reporting initiatives, and integrates key concepts into work.
• Performs other duties as assigned.

Benefits

• Competitive compensation
• Generous retirement offerings
• Programs that invest in your career development
• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees