Director, Risk Management & Patient Safety (KFH/HP)

YK Solutions•Downey, CA

1d•Onsite

About The Position

This position is responsible for overseeing critical risk management projects such as cybersecurity, changes to the reimbursement structure, and the impacts of changes in medical science to hospital performance, among others. It also involves maintaining a culture of continuous learning and interest in critical risk management practices and industry changes, and implementing structure and making recommendations on new processes to monitor various employee and patient physiological and psychological safety health issues.

Requirements

Active Registered Nurse (RN) license required
Recent clinical risk management experience in an acute care hospital setting
Minimum two (2) years of experience managing operational or project budgets
Minimum seven (7) years of experience in a leadership role with or without direct reports
Minimum five (5) years of experience with databases and spreadsheets
Minimum four (4) years of experience delivering training programs
Minimum seven (7) years of experience in clinical setting, health care administration, or a directly related field
Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum seven (7) years of health care experience or a directly related field OR minimum ten (10) years of experience in health care or a directly related field
Professional in Healthcare Risk Management Certificate (CPHRM) within 24 months of hire OR Professional Healthcare Quality Certificate within 24 months of hire
Negotiation
Business Process Improvement
Risk Management
Compliance Management
Health Care Compliance
Health Care Policy
Health Care Data Analytics
Learning Measurement
Community Health
Health Care Coding
Consulting
Managing Diverse Relationships
Delegation
Development Planning
Project Management
Risk Assessment
Health Care Quality Standards
Quality Improvement
Quality Assurance and Effectiveness
Evidence-Based Medicine Principles
Infection Control
Demonstrated expertise in conducting detailed clinical chart reviews
Experience leading root cause analyses and failure mode and effect analyses
Experience with infection prevention program oversight
Experience with architectural infection control consulting
Knowledge of cybersecurity risk in healthcare
Experience ensuring compliance with California regulatory, accreditation, and patient safety standards and guidelines
Strong analytical, leadership, and communication skills to identify risk trends and implement mitigation strategies
Proven experience managing patient safety initiatives and regulatory compliance
Experience with population health needs analysis

Responsibilities

Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies.
Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues.
Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources.
Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.
Serves as the subject matter expert for clinical quality improvement processes and regulations for regions, internal and external committees, and key stakeholders by providing consultation on the interpretation, interaction, and implementation of current policies, regulations, and legislation and advising on the current climate and potential changes which may have long term effects on business operations.
Proactively engages in internal and external committees, projects, and relevant initiatives to implement change and to move QA initiatives forward, as well as to communicate to senior leadership on the various changes and rationale for change.
Fosters collaborative, results-oriented partnerships with practitioners, staff, management, and/or departments across clinical and administrative roles to ensure current and future compliance and advising on changes to organizational policy.
Defines the standards for educational programs to raise awareness for current and changing regulation requirements, internal concerns, and system/database usage.
Identifies barriers to process improvement issues, weighing practical, technical, and organizational capability considerations in addressing issues, and advising on policy changes.
Directs the quality of care complaints and review process by directing and representing the organization at grievance meetings, cases, reviews, referrals, and other mechanisms.
Responds to and directs the preparations of all documentation, records, and information requested for specific and highly sensitive patient case reviews.
Reports trends in the process flow of investigations and claims for red flags, appeal reasons, and overturns, reporting results, and advising on strategic direction.
Defines the standards for the surveillance of quality improvement metrics, cases, quality care incidents, and near misses according to established protocols to ensure equal and consistent application of organizational policies.
Oversees infection prevention and control programs to improve employee and patient safety by directing and prioritizing epidemiological investigations and simulations of significant clusters of infection or serious communicable disease concerns as a part of prevention, surveillance, and outbreak management.
Coordinates, develops, and maintains significant outbreak containment protocols and efforts.
Consults with Administration on infection control implications of architectural design, renovation, and construction.
Directs risk management efforts by defining the standards for corrective action plans for improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across the organization.
Defines the standards for root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches.
Defines the standards for escalating high-risk issues and trends to appropriate entities for resolutions.
Defines the standards for health outcome analysis to continuously monitor oversight effectiveness.
Oversees patient safety programs and initiatives by directing significant event management and response to safety hazards, accidents, incidents, threats, and significant events.
Collaborates with executive management and external personnel to develop patient care and satisfaction programs which aim to improve patient flow, clinical support, patient services, and seamless transition of care.
Oversees development of new clinical quality improvement programs by maintaining relationships with key stakeholders, senior management, peers of other markets, and external stakeholders to set the standards for new program guidelines, metrics, and operational definitions of quality improvement, and ensuring the sustainability of the program.
Serves as a subject matter expert on a variety of health concepts, regulatory requirements, and change management principles to foster the development of programs that optimize clinical quality, safety, or health outcomes.
Provides insight into organizational capability of realizing strategic opportunities to develop as a learning organization by advocating for the program and consulting with senior management, technology stakeholders, and external vendors.
Oversees the systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs by defining the standards for the quality improvement monitoring agenda for the organization that includes all aspects of data management and analysis of trends and patterns of practice.
Directs the interpretation of statistical analysis for management of quality improvement evaluations.
Acts as a subject matter expert in interpreting and applying data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources into business practices and guiding strategy.
Presents and advises on the application of reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) into specified formats for senior and executive internal and external stakeholders.
Oversees regulatory audits and survey efforts within region by serving as the primary contact between applicable government, regulatory agencies, vendors, and key stakeholders for onsite visits and evaluations.
Develops the processes for implementing the standards for audit documentation, information, reports, and tools throughout the auditing process.
Reviews prepared audit documentation, information, and reports for ad hoc and complex auditing.
Directs continuous survey readiness activities to maintain compliance with regulatory standards to adapt to changes in regulatory and organizational requirements.
Oversees the evaluations of the cost effectiveness, practicality, and appropriateness of medical care given to patients by determining the standards for case reviews.
Partners with key stakeholders to ensure standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care are followed.
Resolves systematic concerns with current patient treatment plans to ensure patient needs are met in a timely manner.
Partners with key executive internal and external stakeholders to drive the direction of policy to meet current and future population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others.
Establishes the standards for the evaluation of previous patient cases to monitor utilization metrics (e.g., length of stay, type of treatment, and time of treatment) and advocating for their resolution with key stakeholders.