Manager, Quality

Saint Francis Health System

12d•Onsite

About The Position

Develops and implements the hospital-wide Performance Improvement Program, Utilization Management Program, Medical Staff Services/Credentialing Program, and Regulatory Compliance functions consistent with Administrative, Medical Staff and Board approved plans and regulatory agency standards.

Requirements

Bachelor's degree in a health related field or equivalent in experience.
5 years related experience.
Must have training in performance improvement techniques and methods.
Healthcare quality management experience.
In-depth knowledge of state, federal and regulatory guidelines.
Detailed understanding of statistical methodologies.
Extensive knowledge of third-party payer criteria and utilization review.
Knowledge of reimbursement methods, ICD-10 and CPT.
Strong leadership and motivational skills.
Excellent interpersonal oral and written communication skills.

Nice To Haves

Certified Professional in Healthcare Quality (CPHQ) or Registered Health Information Administrator (RHIA) preferred.

Responsibilities

Develops and implements the hospital-wide performance improvement program.
Coordinates hospital quality activities, provides tracking mechanisms, and reports outcomes to all appropriate committees in a timely manner.
Provides support to medical staff and ancillary service departments in formulating appropriate data review mechanisms and developing appropriate indicators to objectively measure important aspects of care/service.
Coordinates activities with appropriate SFHS personnel involved with quality activities, and serves on SFHS committees as requested to ensure continuity and consistency of quality activities.
Serves as liaison with external agencies and external databases which may request quality management data.
Attends medical staff, hospital staff and SFHS committees as requested.
Provides guidance, resources and support to the medical staff officers and committee members.
Coordinates hospital-wide regulatory survey preparation, follow-up, tracking and reporting.
Develops ongoing program to ensure continual compliance with Joint Commission standards.
Prepares, maintains and tracks budgets for areas of responsibility.
Actively pursues methods to reduce costs and improve efficiency.
Demonstrates proficient knowledge of Structured Query Language (SQL) and database fundamentals for constructing, querying and processing raw data for use with daily tasks such as physician requests, disease management initiatives, quality indicators and utilization management information.
Develops and implements policies and procedures that guide and support the provision of services in the following areas: performance improvement, utilization management, compliance, medical staff services & credentialing, statistical reporting, and hospital survey preparation.
Coordinates the medical student program for the medical staff and hospital.