Director of Performance Improvement

Since 1987,
Laurel Ridge Treatment Center
has been the premier provider of specialized behavioral health and addictive disease services in San Antonio and South Texas. Our 330-bed facility is one of the largest freestanding psychiatric hospitals in the United States. Set on a therapeutic 29-acre campus in north central San Antonio, Laurel Ridges serves as the setting for the treatment for children, adolescents, young adults, adults, veterans and military personnel. Laurel Ridge's comprehensive programs treat disorders such as bipolar disorder, psychological trauma, PTSD, depression and anxiety, mental illnesses and addictive disease disorders such as alcoholism, drug addiction and substance abuse.

Laurel Ridge Treatment Center
is part of one of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS). UHS has been recognized as one of the World's Most Admired Companies by Fortune for 10 years in a row.

Universal Health Services (UHS)

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, our annual revenues were $10.77 billion in 2018. In 2020, UHS was again recognized as one of the World's Most Admired Companies by
Fortune;
in 2019, ranked #293 on the Fortune 500; and in 2017, listed #275 in
Forbes
inaugural ranking of America's Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has more than 87,000 employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

The Director of Performance Improvement directs the process of establishing a comprehensive and integrated performance improvement program which meets regulatory standards for the hospital, partial hospitalization, and outpatient programs. The Director of Performance Improvement strives to emphasize an organization-wide approach in regards to continually meeting and/or exceeding licensing and accreditation standards, in order to deliver quality care and cost – effective treatment. The Director leads and assists with responses to potential quality of care issues; evaluates the effectiveness of measurements and analysis of data throughout the facility; oversees regulatory compliance and provides corrective action plans to licensing agencies, regulatory and accreditation bodies and to external reviewers with contracts for services; coordinates with the CEO and Executive Medical Director to insure a proactive approach to quality care and improving performance throughout the facility.

Qualifications

QUALIFICATIONS

Education: Bachelor's Degree required, Masters Degree preferred.

Related work experience
: 5 to 8 years

Licensure/Certification/Registration:
RN, LPC or LMSW preferred

Quality Professional Certificate preferred

Essential Job Duties/Responsibilities

1. Strategic Planning: Provide a broad vision in the strategic development and direction of the performance improvement program for the hospital. Develop and implement a comprehensive performance improvement strategy that aligns with the organization's goals and objectives. Develop a facility-wide performance improvement plan which meets regulatory standards.

2. Data Analysis & Reporting: Establish a system for collecting and analyzing data related to performance improvement measures for both the inpatient hospital program and the outpatient behavioral health program. Consult with senior staff and directors in the development and analysis of department performance improvement quality measures. Maintain a list of hospital-wide performance improvement indicators which includes monthly and quarterly data, and prepare graphs of performance trends to drill down on issues needing action.

3. Process Improvement & Change Management: Identify opportunities for process optimization and operational efficiencies across the organization. Lead initiatives to streamline workflows, reduce waste, and improve service delivery. Analyze performance metrics and key performance indicators (KPIs) to identify trends, issues, and opportunities for improvement. Prepare and present reports on performance improvement progress to senior management and stakeholders. Develop and implement change management strategies to ensure smooth adoption of performance improvement initiatives. Address resistance to change and build consensus around new processes and practices.

4. Compliance & Standards: Ensure the hospital is continuously survey ready with systems in place for monitoring. Assists the Senior Management Team of the Facility in making critical decisions by providing guidance on licensing, regulatory and accreditation requirements. Lead compliance efforts and route licensing and accreditation standards to leaders and managers as indicated. Responds to potential quality of care issues and prepares

Management Team for announced and unannounced surveys and reviews.

1. Collaboration and Communication: Provide training to staff members on the concepts of performance improvement and the application to patient care via orientation of all new hires, and staff training and participation in PI initiatives. Provide compliance consultation to managers through scheduled Performance Improvement Committee meetings, Senior Staff meetings, and Compliance meetings. Work closely with department heads and teams

to understand their needs and provide support.

1. Patient Satisfaction: Tabulate staff, patient, referral source, and / or physician satisfaction surveys. Lead improvement efforts of satisfaction survey outcomes.

2. Project Management: Participate in the facility Environmental Safety tour/walk-through inspections. Compile reports of actual/potential improvement opportunities identified inthe environment of care. Oversee the planning, execution, and evaluation of proactive performance improvement and continuous quality improvement (CQI) projects to proactively improve quality of care. Manage project timelines, resources, and budgets to ensure successful project outcomes. Conduct proactive risk assessment of a high risk process completed to address safety concerns.

3. Team Leadership: Chair PI Committee Meetings 10 to 12 times yearly. Develop and maintain a record on performance improvement activities and keep PI Committee minutes in an accessible binder. Oversight of HBIPS core measure collection, entry, and performance. Foster a culture of continuous improvement and professional development within the team.

4. Reporting: Ensure timely reporting of all Peer Review reports, assigns classification level and communicates those reports with a severe classification through the appropriate channels. Facilitate the OPPE/FPPE process

10 Innovation: Stay updated on industry trends and best practices in performance improvement. Introduce innovative approaches and technologies to drive organizational growth

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice:

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: or

Pay Transparency:

To encourage pay transparency, promote pay equity, and proactively address regulations, UHS and all our subsidiaries will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees. Salary offers may be based on key factors such as education and related experience.