Manager of Clinical Risk and Quality Improvement

Job purpose

The Manager of Clinical Risk and Quality Improvement manages the day-to-day operations of the organization’s clinical risk mitigation and quality improvement analysis. This role ensures continuous compliance with Federal Tort Claims Act (FTCA) deeming standards and HRSA Health Center Program requirements. The manager identifies clinical vulnerabilities through formal assessments and collaborates with the Data and Analytics Department to interpret dashboards and lead performance improvement projects.

Duties and responsibilities

• FTCA & Clinical Risk Operations
• - Deeming Application Management: Leads the technical data collection and administrative assembly of the Risk Management and Credentialing and Privileging (C&P) sections of the annual FTCA deeming and redeeming applications to ensure all submissions meet HRSA/BPHC standards.
• - Systemic Risk Assessments: Executes comprehensive annual clinical risk assessments across all departments to identify vulnerabilities and satisfy federal requirements.
• - Incident & RCA Coordination: Facilitates investigations into clinical incidents and “near misses,” leading Root Cause Analysis (RCA) in collaboration with clinical leadership.
• - Patient Grievances: Oversees the formal grievance process, ensuring systemic issues are identified and addressed to mitigate organizational liability.
• - Risk Reporting: Synthesizes clinical risk data into high-level reports for the CCO, CMO, and the Board of Directors to guide strategic decision-making.
• - Committee Support: Coordinate the Risk Management Committee, including agenda preparation and minute-taking.
• - Credentialing & Privileging Compliance Monitoring: Monitors the overall compliance of the Credentialing & Privileging system, ensuring that processes for Licensed Independent Practitioners (LIPs), Other Licensed or Certified Practitioners (OLCPs), and Other Clinical Staff (OCSs) meet HRSA standards.
• - Regulatory Auditing: Conducts periodic audits of credentialing files and tracking systems to ensure primary source verification and fitness for duty are documented correctly by the Credentialing Manager.
• - Performance Tracking Oversight: Monitors the administrative framework for Focused Professional Practice Evaluations (FPPE) and Ongoing Professional Practice Evaluations (OPPE) to ensure timely completion.
• - Support to CCO: Provides analyzed clinical data and evidence-based findings to the CCO to support their reporting to the QIC and the Board of Directors.
• - QI Analysis: Partners with the Data and Analytics Department to review generated dashboards, identifying trends and opportunities for clinical performance improvement.
• - Focused Projects: Designs and executes targeted QI projects based on FTCA, The Joint Commission Ambulatory Care and PCMH requirements, and clinical outcomes.
• - Technical Guidance: Facilitates the “Plan-Do-Study-Act” (PDSA) cycle for clinical teams and provides “just-in-time” coaching on QI methodologies.
• - Accreditation Readiness: Maintains clinical documentation for The Joint Commission (TJC) and NCQA PCMH status to ensure workflows meet patient safety standards.
• - Training Curriculum: Designs and implements the annual clinical risk and privacy training plan for all staff to satisfy mandatory FTCA requirements.
• - Staff Education: Conducts educational sessions for clinical and administrative staff on risk reduction and regulatory compliance.
• - Policy Integrity: Leads the drafting and periodic revision of clinical risk policies to reflect current regulatory changes and internal audit outcomes.

Qualifications

• A bachelor’s degree required; graduate degree in nursing, public health, or other relevant field is preferred; at least 5 years of professional experience also required.
• Excellent communication (verbal, written, and presentation) skills.
• Strong project management skills managing complex, multifaceted projects resulting in measurable successes and program growth.
• Quality improvement, systems change, and policy development skills.
• Strong analytic skills; experience mining an EHR for required data.
• Demonstrated knowledge of federal and state regulations.

Benefits

None

Pay

N/A

Schedule

TBD