Quality Improvement Manager

2 weeks ago

San Jose, United States County of Santa Clara Full time

Under general direction, develops, implements, coordinates and facilitates the hospital-wide Quality Improvement/Risk Management (QI/RM) Program for Santa Clara Valley Medical Center.

Learn more about Santa Clara Health System at:

scvmc.org

,

och.sccgov.org

,

slrh.sccgov.org

Facebook I

facebook.com/SCVMC LinkedIn |

linkedin.com/scvmc /

Assesses QI/RM needs and trends for the Santa Clara Valley Health Services program by reviewing current practices, and gathering, compiling and evaluating data related to employees, services, problems reported, and patient feedback;

Oversees preparation for Santa Clara Valley Medical Center Accreditation Survey;

Oversees, promotes, and assists in monitoring compliance with federal, state and Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards;

Plans/executes programs designed to enhance physician, nursing and support staff knowledge of quality improvement and risk management;

Assists in planning, preparing, and compiling reports for federal and state regulatory agencies and JCAHO;

Participates in and may chair or coordinate hospital, agency, or departmental committees related to quality improvement and/or safety/risk management;

Prepares quality assessment/improvement and risk management reports, surveys, and written responses for hospital administration, medical staff, regulatory agencies, and others;

Assists County Counsel/attorneys representing the County and County Risk Management with claims and litigation;

Collaborates with Quality Improvement Managers for health agency programs to ensure that their separate QI/RM programs are consistent with and reflected in the agency-wide program;

Selects, trains, supervises, coordinates and evaluates the work of subordinate professional and clerical staff;

Maintains current knowledge of VMC and Health Agency operations;

Maintains competence and knowledge of current trends in health/medical care standards and QI/RM topics.

Participates in continuing education activities for professional growth, licensure and certification requirements.

May initiate and/or participate in research related to standards, quality improvement, and risk management.

Regularly communicates and coordinates/acts as liaison with managers throughout Valley Medical Center, other health agency divisions, regulatory agencies, relevant professional associations, County Counsel, and other county agencies.

Performs other related tasks as required. Possession of a license as a Registered Nurse issued by the California Board of

Registered Nursing, and the abilities and current knowledge to perform the typical tasks of this position in an acute care hospital;

A typical way to obtain the required knowledge and abilities would be a baccalaureate degree in nursing or the equivalent and a minimum of three years inpatient nursing experience in an acute care hospital of which a minimum of one year has been in an administrative or supervisory capacity.

Knowledge of:

Nurse Practice Act;

Principles and practices of nursing, clinical systems, safety/risk management, infection control, and quality assessment/improvement in an acute care hospital setting;

Current trends, issues, and research in treatment, prevention, and education, as they relate to QI/RM in a large medical services system;

Program management in an acute care hospital setting, including planning, implementation, evaluation, and reporting as required by laws, codes and regulations.

County, state, and federal legislation applicable to contemporary acute care hospital operations and patient care issues; resources for researching legislative issues.

Organization and functioning of an acute care hospital; organizational, personnel, and fiscal management within a health care facility/agency;

Methods, regulations, and procedures for research within an acute care hospital setting.

Ability to:

Organize, direct, coordinate and evaluate acute psychiatric services to ensure quality patient care and conformity with prescribed laws, regulations, and standards;

Work cooperatively with administrators, medical personnel and nursing staff and others to obtain and evaluate information, and implement changes for QI/RM;

Effectively train staff in QI/RM principles and practices;

Prepare complex and detailed written reports and procedures;

Develop and analyze data and maintain accurate records;

Maintain up-to-date knowledge of nursing practice, quality assurance trends/practices, risk management and current legislation;

Communicate effectively at all levels within the clinic and with other departments/agencies, the patients, and the public.

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