What are the responsibilities and job description for the 0000 Facility - Director of Quality Management position at Mount Carmel Behavioral Health?
Overview
PURPOSE STATEMENT :
Direct the facility Quality Management program which includes oversight of Accreditation and Credentialing Activities.
Responsibilities
ESSENTIAL FUNCTIONS :
- Monitor and analyze QM data for review by facility management. Submit data to external agencies as required.
- Conduct annual preparation and evaluation of the facility Quality plan.
- Complete QM projects and incorporates the results into patient care improvements.
- ensure facility compliance with policies and applicable standards as required by regulatory / accrediting bodies.
- Submit monthly scorecard data to Acadia corporate office.
- Complete monthly safety rounds and submit results / corrective actions to Acadia corporate office
- Review incident / safety concerns with the leadership team to identify systemic issues and facilitate the development of corrective actions. Facilitate / oversee investigation and Root Cause Analyses into all serious and / or sentinel events.
- Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.
- Coordinate the abstraction of clinical data according to Joint Commission specifications and data entry via vendor database for Inpatient Psychiatric Core Measures (HBIPS).
OTHER FUNCTIONS :
Qualifications
EDUCATION / EXPERIENCE / SKILL REQUIREMENTS :
LICENSES / DESIGNATIONS / CERTIFICATIONS :
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