JOB SUMMARY:
Your experience matters
At Community Rehabilitation Hospital North,we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, youll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.
How youll contribute:
Leads and oversees a comprehensive, efficient, and integrated hospital-wide Continuous Quality and Performance Improvement (CQPI) program. Uses data collection, analysis, and trending to assess performance; focuses on process and systems improvement; directs risk management and patient safety activities; investigates adverse outcomes; coordinates regulatory/accreditation readiness; and educates staff on CQPI and related quality programs.
QUALIFICATIONS:
Licensure: Registered Nurse with current state licensure highly preferred; clinical license required.
Education: BSN or BS/BA required.
Experience: Minimum two (2) years in an acute hospital or rehabilitation setting required; prior supervisory experience preferred.
Certifications: Basic Life Support (BLS/CPR) required; certification preferred by APIC (American Practitioners of Infection Control) and NAHCQ (National Association of Health Care Quality).
Skills: Data analysis and reporting; CQPI methodologies (e.g., RCA, FMEA, PDSA); risk management and patient safety facilitation; regulatory/accreditation readiness; effective teaching, communication, and collaboration.
ESSENTIAL FUNCTIONS:
Job Specific:
- Provides leadership and oversight of a comprehensive, efficient and integrated organization wide Continuous Quality Performance Improvement program.
- Measures and assesses performance through collection, analyses, and trending of data.
- Focuses on processes and systems to improve performance.
- Directs, facilitates, and reports on all aspects of services relating to risk management and patient safety.
- Investigates factors contributing to adverse outcomes in order to improve processes and systems.
- Encourages reporting on risk reduction strategies in an atmosphere which minimizes blame or retaliation. Fosters environment to reduce unanticipated adverse events and/or outcomes.
- Responsible for education of Continuous Quality and Performance Improvement and additional hospital-wide education and training.
- Directs the functions and operation of the hospital-wide continuous quality improvement program including review of records for indicators of quality; reports findings to leadership, Medical Executive Committee, the Board of Managers and other committees as appropriate.
- Responsible for education of Continuous Quality and Performance Improvement to hospital and medical staff.
- Annually reviews hospital wide plans for the functions of IC and CQPI and establishes goals and objectives for the next year.
- Acts as a liaison to local health officials, coordinates inspections and accreditation reviews with state and other regulatory agencies.
- Demonstrates knowledge of growth, development, and the aging process for the planning and delivery of age-appropriate care.
- Perform other duties as assigned.
Skills:
- Basic computer knowledge.
- Knowledge of basic equipment.
- Appropriate telephone communication skills.
OSHA EXPOSURE DETERMINATION:
- A key element for a successful Exposure Control Plan is to identify situations that place all employees at risk for exposure. To facilitate this, the Hospital maintains a list of job classifications and contact status for all employees in which employees have occupational exposure to bloodborne pathogens. This position has been identified as Category III: Employees who have no occupational exposure to bloodborne pathogens in the normal performance of job duties.
