Leader Quality & Regulatory Services Pasadena, CA
The Quality and Regulatory Services Leader demonstrates strong clinical, consulting, and accreditation/regulatory experience in performance of job duties which includes acting as a back-up to the regional Accreditation&Licensing Director during various cycles of hospital accreditation and regulatory response work. This individual also serves as lead consultant for Clinical/Regulatory information systems for the department, collaborating with Patient Care Services on automation of nursing audits in the medical centers Additionally, this position fulfills a health plan quality oversight function as liaison to Medi-Cal and State Programs and Regional Medi-Cal Strategy departments for regulatory and compliance functions.
- Assists and acts as a back-up with the AR&L Director to achieve regional coverage when two or more hospital surveys or regulatory investigations are conducted on the same day (TJC, CMS, CDPH, or other state or federal entity).
- Provides time-sensitive regulatory consultation to medical center executive leaders and quality/regulatory professional staff (e.g., adverse event reporting, standard or regulation interpretation, corrective action plans to address regulatory findings, 2567 responses).
- Assists AR&L Director in organizing and leading monthly A&L Peer Group meetings.
- Backs up AR&L Director when needed for committee participation and reporting (e.g., SCQC, RCC, and Regional HIMS).
- Serves as active consultant on TJC/CMS site assessment team as a consultant in multiple functional areas including patient safety, nursing practice, and leadership.
- Provides expert consultation on new certification projects. Examples: Joint Commission Disease Specific certifications and California Children's Services (CCS).
- Maintains CCS certification records for the region and monitors re-certification timelines.
- Serves as lead consultant for Clinical/Regulatory information systems projects in conjunction with Patient Care Services.
- Ensures that reports and information disseminated from the unit are accurate, timely, and consistent.
- As assigned, leads or participates in education or consultation projects to address regulatory deficiencies.
- Serves as Health Plan quality liaison to Medi-Cal and State Programs for ongoing audit and regulatory and compliance functions.
- Prepares designated primary care sites/leaders for Health Plan partners' annual audits (e.g., LA Care, Cal Optima, and Inland Empire).
- Serves as advisor to Director Quality and Regulatory Services for NCQA, TJC, CMS, and DHCS survey readiness work which requires clinical/health care operations knowledge base.
- Minimum five (5) years of experience and knowledge in subject matter area of expertise.
- Bachelor's degree in nursing, health care administration, public health administration, business administrationOR four (4) years ofexperience in directly related field.
- Graduate of accredited school of nursing required.
License, Certification, Registration
- Current California RN license required.
- Excellent interpersonal, verbal and written communication skills.
- Ability to work with peers in self-managed teams to meet deadlines.
- Demonstrated conflict resolution and mediation skills with ability to secure action from persons outside their supervision.
- Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate and ask for help when needed.
- Ability to multitask and manage time in order to perform well on long-term projects while being flexible enough to assimilate short term projects on an on-going basis.
- Ability to coordinate multiple priorities and execute deliverables in a timely manner.
- Ability to demonstrate and utilize knowledge of quality improvement/management processes, techniques and systems.
- Working knowledge of federal and state laws and regulations such as TJC, CMS, NCQA, Knox-Keene Act, applicable Medi-Cal and Medicare regulations and rulings.
- Demonstrated ability to utilize skills and knowledge related to adult learning and motivational theories, statistical analysis, quality management and performance improvement processes.
- Demonstrated ability to utilize oral and written communication skills.
- Requires some travel to the Service Areas and/or Regional offices across the Division.
- Personal transportation required for local Service Area travel.
- Must be able to work in a Labor/Management Partnership environment.
- Master's degree in nursing, health services, business administration, or other relevant field preferred.
Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St.
Scheduled Hours (1-40): 40
Working Days: Mon, Tue, Wed, Thu, Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Manager with Direct Reports
Job: QA / UR / Case Management
Public Department Name: Quality and Regulatory Services
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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