What are the responsibilities and job description for the Registered Nurse-Quality and Accreditation Management position at Smart IT Frame?
Registered Nurse-Quality and Accreditation Management
Facility Address : Juneau, AK 99801 ,Sitka, AK 99835(Both location available with same pay with details )
Shift Information : Days, Full Time
Facility Salary : $87,000.00 to $114,000.00
25k sign on, 10k relocation
SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.
Provides and applies clinical knowledge and expertise; advanced critical thinking, knowledge of quality and accreditation. management tools, techniques and processes of a variety of federally or state mandated and / or consortium-wide driven processes. This position coordinates regulatory surveys; continuous accreditation readiness activities; facilitates significant clinical events investigations and reporting; participates in medical staff peer review and medical staff performance data support for hospitals and / or ambulatory setting; conducts medical record review, data analysis, trending and solutions, facilitates education and training around quality, accreditation and safety; chairs committees and teams as applicable, and serves as the expert for quality improvement and accreditation. This position works closely with Administration, Providers, Leaders and Staff to ensure awareness of quality and patient safety, and to facilitate improvement efforts in all areas.
Key Essential Functions and Accountabilities of the Job
May include any and / or all of the below :
- Assists with the development, implementation, and maintenance of a strong Consortium-wide Quality Management (QM) Plan, ensuring that all sites have quality programs that support the overall QM Plan while being integrated into the needs of the various sites.
- Facilitates and promotes quality improvement measures and initiative. Ensures compliance is monitored and reported in an appropriate and timely manner.
- Offers feedback, suggestions and problem solving to ensure that the QM Plan and programs guide SEARHC improvement efforts. Uses skills in data analysis, chart reviews, and other QM tools / methodologies to carry out an effective QM Plan.
- Develops, maintains, and utilizes sound working knowledge of accreditation and regulatory standards (TJC / CMS / OSHA / DNV, etc.) and serves as primary resource for interpretation and application of standards as they pertain to SEARHC.
- Remains actively involved in continuing education / training / conferences to keep abreast of standard changes.
- Facilitates / coaches / guides leadership and staff to better understand regulatory standards and how to meet these in the most proficient manner for the organization and resources allotted.
- Assures appropriate action plans are developed, implemented, and monitored based on data and leading practices as needed to meet regulations.
- Works closely and collaboratively with the QM Manager, front line leaders on quality assessment and risk management issues.
- Investigates all concerns, trends, or risk factors that present risks or safety concerns to patients and the organization.
- Works with Medical Staff leadership and applicable committees on procedural issues related to Medical Staff peer review. This includes the assistance with the development and maintenance of subcommittee specific Clinical Indicators for review.
- Identifies and prepares peer review cases for the Medical Director. This entails detailed chart reviews and a strong clinical background. Assigns and tracks cases designated for review to appropriate staff members.
- Works closely and collaboratively with the Medical Director, CMO, and SEARHC Corporate Counsel as needed, on quality of care and risk management issues stemming from peer review activities.
- Communicates professionally and effectively with all levels of the organization; serves as a resource, mentor, and role model for others as QM is continuously integrated into everyday processes within the organization.
- Other duties as assigned including cross coverage of other QM Team member roles.
Education, Certifications, and Licenses Required
Experience Required
Knowledge of
Skills in
Ability to
Required Certifications
Basic Life Support (BLS) - American Heart Association, Certified Professional in Healthcare Quality - National Association for Healthcare Quality, Registered Nurse License - State of Alaska - Alaska State Board of Nursing
Salary : $87,000 - $114,000
