GENERAL OVERVIEW:

 Works in coordination with the Quality Director to achieve successful implementation of AHN enterprise-wide Quality goals and objectives for designated locations.  Assists with efforts to maximize impact of internal and external quality programs (P4V programs CMS, Payor and Public Reporting) by facilitating and maintaining quality improvement efforts to achieve improved patient outcomes.

ESSENTIAL RESPONSIBILITIES:

• Facilitates achievement of internal and external quality goals through developing, reviewing, and revising polices.procedure related to quality improvement.
• Provides Management support with all hospital quality initiatives.
• Responsible for Quality  project planning, strategy and facilitation of project success.
• Works with facility/AHN leadership to influence/facilitate progress toward goals.
• Organizes and coordinates multidisciplinary quality improvement activities across the hospital to ensure that goals are achieved.
• Assists Quality Director with development of the hospital’s annual PI plan and goal setting.
• Supports the development and implementation of departmental PI plans.
• Positively impacts and Influences care delivery and/or care documentation.
• Maximize P4V program outcomes (e.g., HCQB, CMS). Manages various pay for value projects, including project planning, strategy, analytics and identification and implementation of  performance improvement opportunities to support project success. Supports real-time quality programs such as stroke, CHF, other core measures and other quality measures in coordination with coordinators, nursing management and medical staff division leaders.  Manages the OPPE process. Interacts regularly with Chairman of Medical Staff sharing data to drive decision making and facilitate Medical Staff Performance improvement plans.
• Manages the OPPE process. Interacts regularly with Chairman of Medical Staff sharing data to drive decision making and facilitate Medical Staff Performance improvement plans.
• Assists the Quality Director in coaching and evaluating members of the quality team.
• Other Duties as assigned.

QUALIFICATIONS:

Minimum

• Bachelor’s degree in Nursing or related healthcare field or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 3-5 years experience in healthcare administration
• Demonstrated ability to coach and lead others in problem solving and process improvement. 
• Demonstrated results in achieving or exceeding performance standards within the scope of defined policies, procedures and regulatory standards.
• Demonstrated ability to work in a matrix organization and successfully drive results.
• Demonstrated ability using data to support process improvements.
• Experience accessing electronic databases and also skill in using and creating spreadsheets

Preferred

• Master's Degree in Healthcare Administration, Business, or health related field
• LSS Green Belt or Lean Certified
• Experience in a hospital setting with 4 or more years developing improvement plans, implementing solutions, leading cross functional/matrix work teams.

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.