Quality and Safety Oversight Specialist II, Health Plan / Hospital

In addition to the responsibilities listed above, this position is also responsible for learning about quality improvement systems and organizational accreditation and credentialing; ensuring that the organization meets the standards established by regulatory agencies and accreditation organizations and meets public expectations following clear guidance; documenting and monitoring the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners as directed; learning about systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education; leveraging standardized and established processes for review and approval of medical staff or provider staff Bylaws, Rules and Regulations and amendments; and assisting with monitoring oversight systems of all contracted entities including but not limited to the Permanente Medical Groups.

• Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.


• Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.


• Develops expertise for clinical quality improvement processes and regulations within assigned area by: learning and developing knowledge of current internal policies and relevant external regulations; supporting committees, projects to provide guidance on the enforcement, development of policies or procedures of regulations and auditing processes as directed; supporting collaborative, results oriented partnerships with practitioners across clinical and administrative roles to ensure compliance with regulations and improve patient safety, reporting accuracy, and health outcomes; and preparing materials for educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage.


• Supports the quality review process for quality of care complaints and reviews, with guidance from senior team members by: preparing materials and reports for grievance meetings, cases, reviews, referrals, or other mechanisms as requested; preparing documentation, records, and information as directed; and monitoring cases, quality care incidents, and near misses according to established protocols as requested.


• Assists with infection prevention and control programs to improve employee and patient safety with guidance from senior team members by: assisting with epidemiological research as a part of prevention, surveillance, and outbreak management as requested; and adhering to outbreak protocols and assisting in all outbreak containment efforts within the area of focus.


• Supports oversight and risk management efforts by: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys as directed; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to near misses and good catches in order to identify areas of improvement as requested; assisting with the utilization of health outcome analysis to continuously monitor oversight effectiveness; and assisting with escalating high and risk issues and trends to appropriate entity for resolutions.


• Assists with patient safety and satisfaction programs and initiatives by: reporting safety hazards, accidents, incidents, threats, and significant events promptly; and assisting in the delivery of patient outcomes to improve or implement safer patient practices and services and seamless transition of care.


• Assists in the development of new clinical quality improvement programs by: facilitating meetings with practitioners, teams, and departments to gather information for the development of guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation and peer/department review groups; developing an understanding of a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and supporting the integration of continuous learning orientation into programs to assist with oversight, development, and improvement initiatives.


• Assists in the collection and entry of data into systems, procedures, and forms to improve data management programs and utilizes data from internal and external sources to monitor and evaluate quality improvement initiatives by: conducting descriptive statistical analysis for routine quality improvement evaluations; gathering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and supporting the preparation of reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) into specified formats.


• Assists in regulatory audits and surveys by: assisting with onsite visits and evaluations as directed; preparing requested audit documentation, information, reports, and tools throughout the auditing process, as requested; and communicating to the supervisor on the status of survey completion and any follow-up actions as required for auditing surveys.


• Assists in the evaluation of the cost effectiveness, practicality, appropriateness, and equal application of care to diverse patients by: preparing forms and materials to be reviewed by the supervisor for case reviews; gathering information to support the development of the standard operating procedures for treatment for specific medical codes as requested to ensure equal and timely access to care; gathering information related to current patient treatment plans to ensure patient needs are met in a timely manner; supporting evaluations of population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others; and preparing reports of previous patient cases to identify areas of improvement for length of stay, type of treatment, time of treatment, and barriers to treatment (e.g., language barriers and mobility accessibility) as requested.

Qualifications:

• Minimum one (1) year of experience with databases and spreadsheets.


• Associates degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum one (1) year of health care experience or a directly related field OR Minimum two (2) years of experience in health care or a directly related field.

• Knowledge, Skills, and Abilities (KSAs): N/A