Quality Improvement Specialist

About the role

Coordinates Medical Staff/Provider Quality activities to promote and ensure quality and improvement of patient care across the continuum. Ensures individual, team and organizational processes are implemented in accordance with the governance of the Medical Staff, the philosophy and objectives of Methodist Healthcare-Memphis Hospitals, and appropriate accreditation/regulatory/quality oversight agencies. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Responsibilities

• Coordinates the activities of Medical Staff peer review to promote quality patient care by the ongoing evaluation of the performance and competency of the Medical Staff and other independent licensed practitioners at Methodist Le Bonheur Healthcare.
• Works collaboratively with other departments to ensure patient care is delivered in a safe, effective, timely and efficient manner.
• Provides administrative support, supervision, guidance to all medical staff committees/departmental meetings and members of the elected Medical Staff.
• Strategically identifies, plans, and directs assigned projects based on health care trends, performance analysis, clinical strengths and weaknesses, and accepted quality and performance improvement methodologies.
• Consistently develops and maintains spreadsheets and databases as appropriate or as assigned by department leader.
• Organizes, reviews and prepares clinical summaries and data for ongoing monitoring of provider performance to meet regulatory requirements.
• Monitors all aspects of Performance and Quality Improvement related to the Medical Staff.
• Assists in the design of methodology to create and automate clinical pathway models in support of evidence based medicine in collaboration with physician, nursing and administrative leadership.
• Performs other job functions as assigned or requested.

Education

• Required – Bachelor’s Degree in Nursing

Work Experience

• Required – Progressive experience in a hospital setting (3–5 years)
• Preferred – Prior experience in quality improvement methodologies, such as Six Sigma, Baldrige/TNCPE, or NAHQ

Licenses and Certifications

• Required – Registered Nurse, Tennessee Board of Nursing

Knowledge, Skills and Abilities

• Current knowledge of local, state, federal regulatory/quality oversight agencies’ requirements.
• Knowledge of and experience with hospital accreditation standards (DNV, TJC) to plan and implement performance assessment and improvement measures for compliance.
• Demonstrated skill and proficiency in leadership, interpersonal relations, and coaching to improve performance.
• Strong analytical, communication and presentation skills.
• Proficient with Microsoft Excel, Word, and PowerPoint.
• Ability to use and analyze performance data in Premier, SharePoint, RL/Safeguard and other databases.
• Proficient with electronic health records.
• Ability to facilitate physician teams to accomplish peer review and/or physician evaluations.
• Ability to prioritize and effectively manage multiple tasks.
• Ability to manage change and produce results in a fast-paced environment.
• Ability to work independently and produce results in a matrix environment.

Supervision

Provides supervision of all Senior Leadership Council meetings and activities, Department/Division Committee meetings, performance assessment, and peer review to ensure conformance with Medical Staff Bylaws and Rules and Regulations. There are no lead or supervisory responsibilities for this position.

Physical Demands

The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion. Must have good balance and coordination. The physical requirements of this position are: light work – exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently. The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading. The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.