Clinical Quality Improvement Specialist

4 weeks ago

Baldwin Park, California, United States Kaiser Permanente Full time
Job Summary:

In this role, you will be responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing, risk management, and infection prevention and control. You will contribute to the evaluation, design, and development of evidence-based guidelines, principles, and/or programs related to your area of work, as well as facilitate implementation efforts to reduce variation in clinical practice and optimize patient outcomes.


Key Responsibilities:


Promote learning in others by providing information, resources, advice, and expertise to coworkers and members. Build relationships with cross-functional/external stakeholders and customers.

Listen to, seek, and address performance feedback; provide actionable feedback to others and to managers. Pursue self-development; create and execute plans to capitalize on strengths and develop weaknesses. Lead by influencing others through technical explanations and examples, and provide options and recommendations.

Adopt new responsibilities; adapt to and learn from change, challenges, and feedback. Demonstrate flexibility in approaches to work; champion change and help others adapt to new tasks and processes.

Facilitate team collaboration to support a business outcome. Complete work assignments autonomously and support business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions. Encourage team members to adapt to and follow all procedures and policies.

Collaborate cross-functionally and/or externally to achieve effective business decisions; provide recommendations and solve complex problems. Escalate high-priority issues or risks, as appropriate; monitor progress and results.

Support the development of work plans to meet business priorities and deadlines; identify resources to accomplish priorities and deadlines. Identify, speak up, and capitalize on improvement opportunities across teams; use influence to guide others and engage stakeholders to achieve appropriate solutions.


Conduct data extraction, analyses, and presentations to support quality improvement efforts by: conducting statistical analysis to determine the reliability and confidence intervals for quality improvement evaluations and special projects; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; presenting quality improvement metric reports at the individual and team level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and documenting and analyzing trends, potential errors, and other analysis and reporting finds to the supervisors.


Facilitate quality improvement and improvement risk management efforts by: assisting with the development of corrective action plans for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys; ensuring process improvements are compliant with established internal and external regulation requirements at the local level; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement; and exercising independent judgment to escalate high-risk issues and trends to appropriate entities for resolutions.


Develop and utilize quality improvement performance metrics by: developing performance metrics, standards, and methods to establish improvement success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved for assigned departments; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.


Facilitate the development of quality improvement initiatives by: implementing methods and tools to develop stakeholders' capabilities for process improvements; integrating the use of data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing and updating milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plan.


Serve as the subject matter expert for quality improvement processes and regulations within assigned departments by: learning current internal policies and external regulations; participating on committees, projects to propose a course of action on the enforcement, development of policies or procedures of regulations and auditing processes; fostering collaborative, results-oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; delivering educational programs to raise awareness for regulation requirements, internal concerns, and system/database usage; and anticipating issues, weighing practical considerations in addressing issues, and seeking input from engagement managers/sponsors to resolve.


Deliver stakeholder development and quality performance review efforts by: conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and taking a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and providing feedback and coaching as needed; and delivering and assisting in the development of training and educational programs related to process improvement for quality improvement programs for stakeholders at the team level.


Requirements:
Minimum one (1) year of experience in a leadership role with or without direct reports. Minimum two (2) years of experience with databases and spreadsheets or continuous quality improvement (CQI) tools. Minimum three (3) years of experience in a clinical setting, healthcare administration, or a directly related field. Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum four (4) years of experience in quality, performance improvement, customer service, or a directly related field OR Minimum seven (7) years of experience in healthcare quality assurance/improvement or a directly related field. Registered Nurse License (in the state where care is provided)

Additional Requirements:
Knowledge, Skills, and Abilities (KSAs): Clinical Quality Expertise; Negotiation; Risk Management; Compliance Management; Health Care Compliance; Applied Data Analysis; Health Care Quality Standards; Quality Improvement; Development Planning; Agile Methodologies; Process Mapping; Project Management; Risk Assessment

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