Risk Management Nurse/Quality Manager

About the role

The Clinical Quality Manager (CQM) is a registered nurse who works full time and has the authority and responsibility to identify and implement strategies that control conditions and behaviors which may expose the organization, facility, and staff to risk or financial loss. The CQM ensures resident care objectives are met in accordance with facility standards, policies, and current care practices, working closely with the Administrator and Director of Nursing. This role focuses on identifying potential or actual risks to residents, staff, and visitors, and implementing programs to mitigate these risks.

Responsibilities

• Provides guidance and assists in the implementation and monitoring of resident care objectives, clinical standards, policies, and procedures for the Department of Nursing Services, aligned with facility and current care standards.
• Embraces the facility’s philosophy to deliver care that promotes the maintenance or enhancement of each resident’s clinical status and quality of life.
• Establishes mechanisms with the facility Administrator and Director of Nursing to monitor the delivery of care consistent with state, federal, and facility standards.
• Monitors systems of care, objectives, policies, procedures, staffing patterns, and staff orientation based on resident needs, identifying potential and actual risks.
• Monitors and, at times, delivers care consistent with current nursing standards, documenting and communicating findings to the Quality Management Coordinator and facility leadership.
• Encourages, teaches, and motivates staff to perform resident care functions that enhance quality of life while reducing litigation risks.
• Conducts daily rounds to identify risks, deficient nursing practices, and documentation issues, and designs training programs to address these areas.
• Meets regularly with the Administrator, Director of Nursing, and Quality Management Coordinator to discuss risks and recommend corrective actions.
• Works cooperatively with leadership to implement practices that reduce or eliminate risks.
• Establishes and administers a process for receiving, documenting, tracking, investigating, and acting on complaints or reports of potential liability risks.
• Investigates identified risks and recommends corrective actions to reduce financial loss.
• Identifies educational opportunities for staff and develops/delivers in-service training based on needs.
• Serves as a member or liaison to the Corporate Compliance Committee and as the information privacy liaison for clinical and administrative systems under the Privacy Officer’s direction.
• Maintains current knowledge of federal and state laws, Medicare certification standards, and monitors compliance.
• Serves as a clinical consultant to the facility for all clinical staff.
• Represents the facility’s interests with external parties (e.g., government bodies) during audits, surveys, or compliance monitoring.
• Performs other duties as assigned by the Director of Nurses, Quality Management Coordinator, or Administrator.

Requirements

• Must possess comprehensive knowledge of nursing practices for aged, chronically ill, and convalescent residents.
• General knowledge of the Medicare/Medicaid program and current federal/state regulations for skilled (SNF) and nursing (NF) facilities, including the Nursing Home Care Act, Oklahoma Nurse Practice Act, and OSHA’s Bloodborne Pathogen Standards.
• Familiarity with facility policies and procedures to ensure compliance in all aspects of resident care.
• Knowledge of the legal process and ability to identify liability risks.
• Strong interpersonal and leadership skills.

Qualifications

• Licensed as a Registered Nurse in Oklahoma and in good standing with the Oklahoma Board of Nursing.
• Must maintain an active nursing license and provide evidence of renewal as required.
• Two years of prior experience in long-term care, with knowledge of risk management, legal issues, and direct resident care preferred.
• Moderate computer literacy to complete online tasks and documentation.
• Ability to communicate and interact professionally with staff and residents.

Physical Requirements

• May be required to lift, carry, turn, or assist high-risk residents.
• Able to sit, stand, bend, and move intermittently during work hours.
• Must be able to lift, push, and carry 40 pounds with two hands and 20 pounds with one hand.
• Willing and able to work a flexible schedule.

All candidates must be able to perform the full range of job functions outlined in this description.