Overview

JOB SUMMARY: Facilitates, directs, coordinates, and provides guidance and education to the Administrative team, physicians, department heads and other employees in UR/QI and related areas.

Responsibilities

A. KNOWLEDGE OF WORK1. Accurately aggregates data for presentation to the Medical Staff committees and departments to encourage and ensure improvement of processes. 2. Demonstrates a thorough knowledge of JCAHO standards, CMRI objectives, lnterqual, Title 22 and CDC guidelines. 3. Demonstrates a thorough knowledge of Patient Review Department policies and procedures and makes appropriate changes. 4. Keeps abreast of all current Federal and State regulations

B. DUTIES AND RESPONSIBILITIES1. Insures a high level of quality in patient care by assisting departments organizing a well-defined and well documented case management program. 2. Assists administration and the medical staff by providing accurately compiled and tabulated data required to monitor and evaluate patient care. 3. Coordinates assessment of quality control issues, sentinel events and other concerns with the medical staff and hospital departments or committees. 4. Provides accurate analysis of information reports data and aggregates that data for identification of patterns or trends. 5. Assists with in-service of hospital departments and staff on the purpose, goals and objectives for hospital wide quality program. 6. Manages the patient review department including: Case Management, Social Services, Discharge Planning, Utilization Review, Denials Management 7. Assures efficient and appropriate use of hospital resources. 8. Insures a systematic approach in the coordination of risk management and infection control programs. 9. Participates in the development of capital equipment and operating budgets and maintains operation of the Patient Review Department within approved budget. 10. Maintains a sufficient flow of work in the department and reviews to ensure completeness, accuracy and timeliness. 11. Actively participates in department manager meetings and other designated committee meetings. 12. Exhibits the ability to use good judgment in the hiring of employees and plans appropriate orientation and training. 13. Exhibits the ability to counsel personnel with disciplinary actions up to and including the termination of their employment using effective interaction with the employee and assuring that all action is in a lawful and proper manner. 14. Demonstrates the ability to recognize and deal with priorities. 15. Demonstrates a cost-conscious attitude in time usage and always makes the best use of time. 16. Performs special projects and assignments in an accurate, efficient and thorough manner. 17. Presents a positive image of the hospital to patients, visitors, physicians, and the public. 18. Promotes harmonious relationships within the department and with other hospital departments. 19. Always handles telephone information requests with courtesy, accuracy and respect for confidentiality. 20. Always maintains and respects department, patient, and employee confidentiality. 21. Prepares and reviews personnel performance evaluations by the due dates. 22. Arranges timely attendance of staff at workshops, seminars and hospital in-service programs. 23. Assists in the areas of the department between primary responsibilities, assisting others. 24. Organizes self and priorities so that tasks are completed on a timely basis. 25. Performs other duties as assigned.

C. INITIATIVE AND JUDGMENT/ATTENDANCE AND RELIABILITY1. Independently recognizes and performs duties which need to be done without being directly assigned. Establishes priorities; organizes work and time to meet them. 2. Recognizes and responds to priorities, accepts changes and new ideas. Has insight into problems and the ability to develop workable alternatives. 3. Accepts constructive criticism in a positive manner. 4. Adheres to attendance and punctuality requirements per hospital policy. Provides proper notification for absences and tardiness. Takes corrective action to prevent recurring absences or tardiness. 5. Uses time effectively and constructively. Does not abuse supplies, equipment, and service. 6. Observes all hospital and departmental policies governing conduct while at work (e.g., telephone and computer use, electronic messaging, smoking regulations, parking, breaks and other related policies).

SECTION II: SERVICE EXCELLENCE1. Understands, respects and displays sensitivity to culture, age and persons with disabilities. 2. Participates actively and positively affects the outcomes of customer service activities. 3. Uses effective collaborative strategies as evidenced by: a) Developing peer relationships that enable the work group to accomplish the daily workload within the allotted time frame and achieve departmental goals. b) Recognizing and understanding that as a member of an interdependent group, collaboration and compromise is required in order to maintain the effectiveness of the group as a whole to effectively resolve problems. c) Timely notification to Department Manager/Director of potential problems or concerns. When faced with a problem or concern, is proactive by presenting suggested solutions at the time that the Department Manager/Director is made aware of the problem or concern. d) Displaying teamwork ability to promote cooperation and collaboration; gaining support for programs and goals. e) Supports Patient Rights. 4. Displays honesty and respect for others, and respect for the organization as evidenced by: a) Treating internal and external customers as the most important part of the job. b) Being sensitive to customer’s emotions, thoughts and feelings. c) Refraining from negative comments of any kind where the public or other customers can hear. d) Taking appropriate actions to resolve the concern. 5. Facilitates and enhances communication as evidenced by: a) Effective and timely processing of customers requests according to hospital and departmental policies. b) Utilizing verbal communication methods, which enable others to clearly understand what is being said. c) Utilizing verbal and non-verbal behaviors without being defensive, manipulative, aggressive or controlling. d) Using written communication that is legible, timely and at a level based on the position specific requirements. e) Listening attentively to ensure effective two-way communication. f) Expressing and accepting feedback in a professional manner. g) Answering the telephone with stating department, name and greeting. 6. Interacts with coworkers, other hospital staff, physicians, and the public in a courteous, professional and efficient manner. 7. Establishes good rapport and working relationships with coworkers, other hospital staff, physicians and the public 8. Observes dress code policy and wears hospital identification as required by our policies and procedures.

SECTION III: CONTINUOUS QUALITY IMPROVEMENT 

A. CORPORATE INTEGRITY1. Understands and abides by all departmental policies and procedures as well as the Codes of Ethics, HIPAA requirements and patient rights. 2. Complies with federal, state, local laws that govern business practices. Complies with all Department of Health Services requirements for the State of California, and HCFA standards that apply to the position. 3. Is knowledgeable and adheres to JCAHO/DHS/CMS standards specific to the position. 4. Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position. 5. Conducts business in an ethical and trustworthy manner at all times when dealing with patients, visitors, physicians, and fellow employees.

B. EDUCATION AND ENVIRONMENT OF CARE1. Attends scheduled inservice and mandatory inservice. Communicates ideas to supervisor for a safer layout of equipment, tools, and/or processes. 2. Follows standard precautions and transmission based precautions as shown by consistent use of appropriate personal protective equipment. 3. Adheres to procedures for the disposal of waste – household waste and biohazard waste as well as the proper disposal of sharps. 4. Uses proper body mechanics and safe patient handling devices at all times. Seeks assistance when necessary to move heavy objects or to transport/transfer a heavy patient. 5. Is knowledgeable in the hospital safety program and takes necessary steps to maintain a safe environment. Adheres to safe work practices in order to prevent injuries and illnesses. 6. Is familiar with emergency codes and emergency preparedness procedures and understands his/her role in response to each of the emergency codes 7. Maintains the department in a neat, clean, and orderly manner, especially in own work area. 8. Eliminates or assists in eliminating any seen or known hazards in the workplace. Reports any unsafe conditions to his or her immediate supervisor. 9. Demonstrates good safety habits and judgment by maintaining a safe environment at all times. 10. Complies with all hospital safety and injury prevention policies and regulations (seven Environment of Care plans and hospital safety policies and procedures).

C. PERFORMANCE IMPROVEMENT1. Understands the Continuous Quality Improvement Process and applies it in performing everyday tasks/duties. Active participant in Continuous Quality Improvement program by assisting in finding new and better ways of performing duties and responsibilities. 2. Understands performance improvement concepts and demonstrates understanding by:a) Defining performance improvement, and verbalizing at least one major goal of the performance improvement program within the hospital setting.b) Ability to describe a quality improvement problem solving process (e.g., PDCA) and how its use assists in reaching improving patient outcomes and/or organizational quality improvement goals.c) Able to verbalize at least one departmental or hospital wide improvement initiative that has occurred within the last 12 months. 3. Cooperates with others in the improvement of services offered at our institution. Continually makes recommendations that assist in the improvement of services. 4. Continually strives for self-improvement in areas of responsibility by attending continuing education classes.

Qualifications

RN, BS in Health Care Management or related field, Management Experience.