Quality Assurance Specialist II

About the role

The Quality Assurance Specialist II (Quality Management (QM) Specialist) performs complex (journey-level) quality management work. Work involves assisting with planning, developing, and implementing departmental and hospital-wide QM programs to include policy, QSO (Quality System Oversight) monitoring, Restraint/Seclusion processes, and other performance improvement activities. Ensures compliance with The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS).

Responsibilities

• Attends work on a regular basis and may be asked to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
• Reviews hospital policies, prepares and disseminates information to policy managers for review. Provides guidance and education with regard to organizational and statutory requirements as well as accreditation standards. Ensures policies are approved, updated, and posted for staff.
• Captures monthly samples, updates, and distributes audits in a timely manner. Provides education and support to auditors. Completes data entry within the time constraints provided. Aggregates data and compiles reports, as well as trend analysis information. Communicates regularly with the corresponding Central Administration program coordinator.
• Serves as data oversight coordinator for assigned Quality Assessment and Performance Improvement (QAPI) indicators (such as restraint/seclusion, injuries/falls, Length of Stay (LOS), national benchmarks, Patient Tracers, etc.). Monitors documentation of incidents to include a tracking system. Aggregates data. Coordinates committee meetings, compiles all agenda documents. Compiles reports for hospital committees and Governing Body. Compiles trend analysis information compiled for the Quality Management Director.
• Oversees the submission of reports to the Hospital Executive Committee and on to the appropriate committees of the State Hospital System Governing Body.
• Prepares, edits, and distributes correspondence, reports and documents. Maintains filing and records management systems.
• Completes other audit assignments as need arises (The Joint Commission monitoring, performance improvement projects, etc.).

Requirements

Knowledge of local, state, and federal laws related to program area.
Knowledge of TJC and CMS standards
Knowledge of statistical analysis processes, research techniques, training techniques and project management processes.
Skills in interviewing and analyzing data.
Skills in the use of computer and applicable software
Ability to plan, coordinate, and administer quality improvement programs.
Ability to identify problems and develop solutions.
Ability to communicate effectively.
Ability to provide guidance to others.

Qualifications

• Graduation from an accredited four-year college or university with major coursework in social services, nursing, psychology, or a related field is preferred, and a minimum of six months experience required.
• Associate degree and a minimum of twenty-four months experience required.
• No degree and a minimum of four years of experience required.
• Two years of experience in social services, psychiatric/health care, auditing or investigating work; and developing plans of correction.

Skills

• Knowledge of local, state, and federal laws related to program area.
• Knowledge of TJC and CMS standards
• Knowledge of statistical analysis processes, research techniques, training techniques and project management processes.
• Skills in interviewing and analyzing data.
• Skills in the use of computer and applicable software
• Ability to plan, coordinate, and administer quality improvement programs.
• Ability to identify problems and develop solutions.
• Ability to communicate effectively.
• Ability to provide guidance to others.

Benefits

Comprehensive benefits package including 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

Pay

$3,793.41 - $5,921.25 per month

Schedule

Day Shift