Quality & Safety Improvement Consultant III, Clinical Quality Consulting (KFH/HP)

Job Summary:

In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; assisting with the evaluation of evidence-based guidelines, principles, and/or programs related to area of work as well as supporting development and implementation efforts to reduce variation in clinical practice and optimize patient outcomes; assisting with the collection, analysis, reporting, and presentation of clinical data for a variety of users including for state, federal, and local agencies; helping to provide education on interpreting compliance methods when preparing for regulatory reviews, interpretation of regulatory requirements, and regional project goals; monitoring and reporting all occurrences which may lead to medical center liability and providing recommendations on mitigation plans; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and participating in the collaboration with applicable government agencies, regulatory agencies, and other organizations.

Essential Responsibilities:

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Conducts data extraction, analyses, and presentations to support quality improvement efforts by: conducting descriptive and inferential statistics for quality improvement evaluations; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; preparing quality improvement metric reports at the individual level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and identifying and documenting trends, potential errors, and other analysis for further review and reports them to the supervisor.
• Supports quality improvement and improvement risk management efforts by: assisting with the development of corrective action plan 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; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to near misses and good catches in order to identify areas of improvement; and assisting with escalating high-risk issues and trends to appropriate entity for resolutions.
• Develops and utilizes quality improvement performance metrics by: implementing and 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; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.
• Facilitates the development of quality improvement initiatives by: implementing methods and tools to develop stakeholders capabilities for process improvements; applying data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing milestones, detailed workplans, and documentation practices.
• Serves as the subject matter expert for quality improvement processes and regulations within assigned area by: learning current internal policies and external regulations; participating on committees, projects to provide guidance on the enforcement, development of policies or procedures of regulations and auditing processes; leveraging collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; and preparing materials for educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage.
• Delivers stakeholder development and quality performance review efforts by: coordinating and conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering training and educational programs related to process improvement for quality improvement programs for stakeholders.