Quality Assurance Manager bei Virginia Garcia Memorial Health Center

Job Title:          Quality Assurance Manager
FLSA:             Salaried “Exempt”
Base Salary:          VG-120
Department:         Administration
Representation:    Not Represented
Reports to:         Director of Quality

At Virginia Garcia Memorial Health Center, we honor all members of our community and acknowledge the dignity of each person we serve. Our purpose is to provide high quality, comprehensive primary health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and a view to removing barriers to health care. We strive to provide an environment that welcomes and values the people we employ and serve.

If you are unsure whether you meet all the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply.

Job Summary:  The Quality Assurance Manager collaborates with Medical, Dental, Pharmacy and Behavioral Health clinical and operational leadership to ensure compliance with clinical standards and regulations.  The role develop systems to respond to, and prevent, adverse patient outcomes. The Quality Assurance Manager coordinates the review cycle for the Center’s policies and procedures related to patient safety and patient experience. This position directs the patient experience survey process, analyzes and communicates results and supports site leaders in efforts to improve patient experience of care. The Quality Assurance Manager supervises the patient engagement specialist, coordinates the response to patient grievances, and supports site leaders and care teams through the facilitation of patient care conferences, assuring the patient is always centered in the process.  

Essential Duties and Responsibilities:
Patient Experience:
•    Supervise Patient Engagement Specialist and support patient council implementation across all clinic campuses.
•    Lead response to patient complaints and grievances; coordinate with clinic leaders to support them in facilitating person-centered, trauma-informed conversations leading to agreements for care and coordinated care conferences.
•    Serve as primary contact with patient experience surveys (CAHPS) vendor.
•    Support sites in evaluating and improving patient experience. 
•    Collaborate with department leaders to develop and implement training that promotes patient experience, patient safety and supports customer service activities. 
Incident Portal Management:
•    Review and track response to events submitted through the incident portal, meeting established goals for time to incident review and closure.
•    Monitor trends in incidents across the organization to identify opportunities for system improvement for safety and care quality.
•    Generate and share reports of incident submissions with service line and site leaders.
•    Support clinical risk assessment activities related to patient care quality, experience and safety to meet external program requirements (i.e. FTCA).
•    Conduct reviews of sentinel events; organize initial response, coordinate Root Cause Analysis (RCA) meeting with staff and providers, and follow-up on findings and recommendations from RCA.

Quality Review of Systems:
•    Review and update organization policies and procedures related to patient safety, experience and quality assurance monitoring.
•    Coordinate peer review activities in partnership with clinician leaders and subject matter experts.
•    Contribute to development of clinician and site dashboards on patient experience, incidents, peer review and other metrics of quality and safety to inform coaching and credentialing processes.
•    Identify issues related to staff and patient safety and experience, and partner with leaders to develop and/or standardize systems to improve outcomes.
•    Partner with quality, compliance, health and safety, and other leaders and team members to design and deploy ways to monitor and improve safety and quality of care, including participation in internal clinic site visits and developing staff trainings.
Oversight and Reporting:
•    Participate in external site visits and certification processes, serving as a lead, coordinator, coach or participant depending on oversight agency.
•    Create and present reports reflecting measures of quality, safety and patient experience for quality committees, organization leaders and Board of Directors.
•    Contribute to, review and update of the Virginia Garcia Quality Management Plan.
•    Manage budgets for the program and grants.
•    Collaborate with department leaders in clinical risk management activities supporting FTCA requirements..
•    Perform other duties as assigned.
•    Handle protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HIPAA Requirements:
The Quality Assurance Manager will have access to PHI to assess the quality assurance and improvement activities of the center and to address patient complaints about aspects of their care, both medical and billing. Applying the minimum necessary standard of HIPAA, the designated records sets to which this employee will have access include: the patient scheduling, demographic and account information (view only) in the practice management system, and all of the medical record.  
   
Knowledge, Skills and Abilities Required:
•    Strong analytical reasoning, interpreting and evaluation of complex information.
•    Strong project management and inter-departmental coordination.
•    Ability to develop and manage high-level plans and strategies.
•    Knowledge of patient safety strategies.
•    Proficiency with Microsoft Office suite (Word, Excel, PowerPoint, Outlook) and database software.
•    Strong communication skills, both verbal and written.
•    Ability to maintain confidentiality.
•    Ability to work independently and on interdisciplinary teams and workgroups.

Education and Experience Required:
•    Registered Nurse (BSN) or comparable clinical licensure required.  Master’s degree in healthcare field preferred. 
•    Three years of experience required either practicing in a primary care clinic (FQHC preferred) or working in healthcare quality and risk management in another medical setting. 
•    Experience with policy, procedure and/or protocol development.
•    Demonstrated experience with quality assurance methodologies and performance measurement.

Behavioral Competencies:
Accountability
•    Role model VG’s mission, vision, and shared values
Customer-Focus
•    Listen to the voice of the customer and strive to delight them by exceeding their expectations
Teamwork
•    If someone needs help, help them
Initiative
•    Be innovative, apply fresh ideas, and continuously improve how you do your work
Confidentiality
•    Maintain strict confidentiality and respect the privacy of others
Ethical
•    Demonstrate integrity, honesty, and stewardship in all encounters at work
Respect
•    Demonstrate consideration and appreciation for co-workers and patients
Communication
•    Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others

Physical requirements: 
•    Computer Use: up to 90% of the time
•    Sitting: up to 80% of the time
•    Bend, reach, stoop, and walk to get patient charts: up to 10% of the time
•    Lifting/Carrying: up to 5% (frequent 5-15 lbs.; infrequent 15-25 lbs.).

Working Environment/Physical Hazards:
•    Work in well-lighted, ventilated environment.
•    Potential exposure to blood borne pathogens and hazardous chemicals.

Equipment Used:
•    Computer, printer
•    Telephone, fax, copier, scanner
•    Projector

Immunization:
Staff members must meet immunization requirements as stated in VGMHC’s immunization policy and state and federal guidelines.

Job descriptions represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC’s Mission.

VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status, or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes fairness in placement, promotion, transfer, rate of pay, and termination.