Quality-Patient Safety Program Manager

About the role

The Quality-Patient Safety Program Manager supports, coordinates, and facilitates quality management, patient safety, and regulatory performance improvement activities for the hospital and medical staff. This role also serves as a resource to employees, management, nursing directors, senior management, councils, physicians, and teams on quality management activities and handles patient sensitive and confidential hospital information.

Responsibilities

• Aids in designing, planning, implementing, and coordinating quality management, patient safety, and performance improvement activities for assigned hospital and medical staff departments, committees, divisions, service lines, and functions.
• Coordinates and facilitates performance improvement teams to support key initiatives, such as clinical quality improvement, patient safety, risk reduction, patient experience, efficiency, FMEAs, root cause analyses, and medical staff improvement (e.g., case review for peer review, OPPE, FPPE).
• Ensures compliance with CMS HIQRP/HOQRP, TJC, Leapfrog, etc., by participating in data collection and reporting of process and outcome measures.
• Facilitates the development and implementation of data collection tools and processes, including identifying data elements needed for measurement, performing data collection and abstraction according to specifications, and validating data before submission or previewing reports for publication.
• Maintains current knowledge of accreditation and licensing requirements and acts as a resource to staff on these regulations to improve management of outcomes and ensure compliance.
• Assists with regulatory readiness and survey preparation activities, including mock survey tracers.

Requirements

• Licensed Registered Nurse, Licensed Clinical Pharmacist, or other Licensed Clinical Staff with at least 3 years of clinical experience in an acute care setting.
• Ability to perform case reviews for medical staff peer review and medical and/or surgical Registry Abstraction.
• One year healthcare-related quality management/performance improvement experience (e.g., chart audit, PI team member, etc.).
• Current state license in a clinical field in the state of practice.
• Certified Professional in Healthcare Quality (CPHQ), Healthcare Quality and Management Certification (HCQM), or Certificate of Professional Healthcare Quality and Patient Safety (CPQPS) within 2 years of employment is required.

Qualifications

• Experience in an acute care setting.
• Knowledge of accreditation and licensing requirements.
• Ability to maintain confidentiality and handle sensitive information.

Skills

• Strong organizational and project management skills.
• Excellent communication and interpersonal skills.
• Proficiency in data analysis and report generation.
• Ability to work collaboratively with various stakeholders.

Benefits

CommonSpirit Health offers a comprehensive benefits package, including medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition reimbursement, retirement plan benefits, and more. For more details, please refer to the Total Rewards section.

Pay

The posted compensation range is $32.30 - $48.05 /hour, reflecting the lowest to highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. The actual pay may vary based on the candidate's licensure status.

Schedule

This role is full-time with 80 hours per pay period and works Monday through Friday, 8-hour shifts.