Director of Clinical & Quality Services

Position Summary:

This position is responsible for the overall direction of the Clinical and Quality programs under the leadership of the Chief Medical Officer/Medical Director. Provides direct oversight and hands-on leadership for the delivery of comprehensive, effective, quality and timely healthcare, by assuring clinical workflows, patient wait-times, patient satisfaction and clinical competencies are optimized.

Works with providers and management to improve clinical and quality deficiencies; providing statistical data, benchmarks, training and strategies based on state and national standards. Directs the Corporate Compliance Program by managing general liability and risk exposures including, but not limited to: (HIPAA, FTCA, Patient Complaint and Grievances). Directors and coordinates efforts between departments with EHR reports, templates and data analysis. Directly oversees the Nursing Director and QI/Risk Manager. Is the key liaison in bridging gaps of care within the clinical and quality Departments.

Job Responsibilities:

• Serves as TAPM’s Corporate Compliance and HIPAA Officer
• Directly oversees Nursing Director and QI/Risk Manager and departments
• Serves as the primary point of contact for oversight of TAPM CLIA waived labs
• Provides lab assistance to clinical staff in conjunction with the Nursing Director, under the direction of the Chief Medical Officer/Medical Director.
• Assists the Chief Medical Officer/Medical Director along with the Quality Committee in the coordination of the Quality Improvement (QI) plan to include objectives, policies, standards and corrective procedures, and directs strategic plan activities.
• Directs the activities of the TAPM’s Quality Program and Clinical Measures.
• Trains, assists and monitors clinical workflow flow in an effort to meet quality initiatives and decrease clinical (nursing and provider) errors.
• Directs the Quality Department to Assist nursing and clinicians in the planning of a systematic, organization-wide approach to identifying measurable indicators for quality standards and improve performance and meet set goals.

• Oversees the FTCA (redeeming process), and assures the clinical and quality teams are following the protocols.

• Develops and maintains Corporate Compliance Policies and Procedures, and investigates internal liability claims to minimize risk of potential lawsuits
• Evaluates the effectiveness of TAPMs Clinical and Quality programs, and analyzes all assigned areas for opportunity of improvement, and makes applicable recommendations for process, system, procedure and operational changes. Utilizes data and outcomes to improve the overall health of the organizations clinical and quality programs.

• Works with IT, providers and management to maximize and develop methods for data extraction through the EHR system, updating and creating templates, reports vetting new services.

• Monitors, reports and provides strategic work plans for timely and efficient clinical work flows, patient wait-times, patient satisfaction and clinical competencies.
• Manages the processes involved in general liability and risk exposures for all TAPM facilities.

• Serves as one of the lead directors for HRSA Compliance
• Provides assistance through the quality department for managers, clinicians, and practice staff with the preparation and assessment of quality reporting, including but not limited to TAPM clinical protocols and grant required indicators.
• Directs the leading of PDSA’s and Leads process improvement teams in the development of process improvement plans, consistent with the quality protocols and standards identified by HRSA, CCNC, AAP, HEDIS, NCQA, etc.
• Works closely with clinical and non-clinical teams for improvement of key performance indicators, designs processes for new initiatives, services and other targets identified by TAPM board and leadership
• Identifies applicable licensure and accreditation regulations and standards.

• Ensures the organization is notified of changes in standards and conditions
• Directs the process of internal and external requests for chart audit
• Reviews and prepares annual reports on patient grievances, complaints and liability

Education:

Bachelor's degree in health related field, Master’s degree preferred. RN, LPN or advanced clinical licensure.

Certification in Healthcare Quality Management or Risk Management and Compliance.

Experience:

Minimum four years of experience in health care setting with minimum of three years’ experience in quality, compliance, nursing or other clinical practitioner. Familiar with all state and federal compliance regulations and standards.

Requirements:

Current state of North Carolina RN, LPN or advanced clinical license, or current Registered Records Administrator Certificate. Certification in Healthcare Quality Management, or Risk Management and Compliance.

Knowledge:

1. Knowledge of TQM concepts, methods and tools including understanding of NCQA, HEDIS, utilization management and risk management.

2. Knowledge of Corporate Compliance and HIPAA

3. Knowledge of how to use computer applications including spreadsheet software.

4. Knowledge of medical records and clinical care processes.

Skills:

1. Skill in effective education and facilitation of TQM efforts in clinic.

2. Skill in understanding of analytical methods and statistical software packages by developing appropriate reports.

3. Skill in medical records, QI, UM and RM through facilitation of issue identification/resolution with variety of audiences.

Abilities:

1. Ability to communicate knowledge effectively both verbally and in written form in informal and formal settings.

2. Ability to work effectively as member of interdisciplinary teams.

3. Ability to plan and organize time appropriately.

Environmental Working Conditions:

Combination of office and classroom settings. Frequent contact with physicians, staff and public.

Physical/ Mental Demands:

Variety of sitting, standing, walking. Occasional stress from dealing with people who are upset.

Confidential Information:

Works with some confidential data of major importance, such as patient records, and patient/family salary/personal information, corporate financial statements, etc., which, if disclosed, may be detrimental to the company’s interests.

Safety:

TAPM expects all employees to work with safety as a priority. The safety of our employees and our patients are extremely important to our organization.

Quality Improvement

Must understand and help enforce the meaning of quality improvement:” The combined and unceasing efforts of everyone-healthcare professionals, patients, and their families, researchers, payers, planners and educators-to make the change that will lead to better patient outcomes, better system performance and better professional development.”(Batalden, 2007). Committed to promoting TAPM as a medical home and incorporating the core components of a Patient Centered Medical Home into your position on a daily basis.

1. Patient Centered
2. Comprehensive care
3. Team-based
4. Coordinated
5. Accessible
6. Focusing on Quality and Safety

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Loan Repayment Opportunities

As a Federally Qualified Health Center (FQHC), Triad Adult and Pediatric Medicine, Inc. has access to resources to assist with the repayment of federal loans if the recipient practices within one of the following disciplines:

• Family Medicine Physician (MD or DO)
• Family Nurse Practitioner (FNP)
• Pediatric Nurse Practitioner (PNP)
• Physician Assistant (PA)
• Pediatrician (MD or DO)
• LCSWs
• Nurses

National Health Service Corp program at http://nhsc.hrsa.gov/loanrepayment/