11/14/2006 43389

QUALITY ASSURANCE/RISK MANAGEMENT DIRECTOR

DEFINITION: This is professional and administrative work directing quality assurance/risk management (QA/RM) program operations for clinical accountability within a state treatment facility or community-based service delivery system.

An employee in this job plans, organizes, and directs the work of an integrated, interdisciplinary, professional staff that monitors and evaluates a QA/RM program within the Department of Public Welfare (DPW) for a state mental health or mental retardation facility, or a region within DPW’s Office of Mental Health and Substance Abuse Services or Office of Developmental Programs; the Department of Military and Veterans Affairs’, Bureau of Veterans Homes; or a Department of Corrections forensic treatment center located within a state correctional institution. Work involves interpreting federal and state requirements and developing and implementing QA/RM operating structures, policies, procedures, evaluation studies and reports to monitor practices and practitioner performance in delivering clinical services and providing non-clinical support. An employee collaborates with clinical managers, facility administrative staff, county and community-based service providers and department officials to establish QA/RM goals, objectives, standards and criteria to identify and minimize high risk issues and measure the quality and appropriateness of patient/individual care against national, state and facility specific care standards. Work at this level is characterized by the scope of responsibility and authority for direct supervision or oversight of a diverse staff of non-clinical and clinical interdisciplinary practitioners responsible for infection control, utilization review, medical records, and the QA/RM program and other related functions for a treatment facility or community-based service delivery system. An employee is expected to exercise initiative and independent judgment in assuring the QA/RM program meets applicable departmental, governmental auditing, Medicare, Medicaid, U.S. Department of Veterans Affairs, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Centers for Medicare/Medicaid Services (CMS) standards. Work is performed under the general direction of the facility administrator or other administrative official and is reviewed through conferences, reports, and evaluation of the effectiveness of results achieved.

EXAMPLES OF WORK: Plans, develops, directs, and evaluates an integrated facility-wide, regional or departmental interdisciplinary clinical and non-clinical QA/RM support program.

Directs, coordinates and oversees the development, implementation and outcomes of clinical practices and mental health and substance abuse services delivered by state mental hospitals, managed care organizations or community-based programs.

Develops benchmarks and standards for state hospitals, community-based programs, state veterans’ home long-term care facilities or managed care organizations to meet department goals.

Provides technical assistance and referral information about medical consultations, clinical coordination, level of care criteria, new medications, risk management, contract services, policy development and clinical oversight.

Develops operational plans, policies, procedures, and time tables for QA/RM activities to be implemented.

Organizes and consolidates ongoing facility-wide, regional or departmental service delivery monitoring to minimize possible liability and ensure quality care.

Directs the review of reports about incidents, medication, and third party liability and the investigation of problems, complaints and inquiries to recommend appropriate corrective action.

Collaborates with facility or program office officials to design and implement actions to identify and correct deficiencies.

Conducts need assessments and develops goals and objectives for the facility's, region’s or department’s annual plan and budget requests to ensure cost effective improvements in patient/individual care.

Consults with facility leaders, facility department heads and other clinical staff for clinical credential requirements and non-clinical practice issues affecting healthcare, treatment and safety.

Monitors QA/RM activities, such as medical staff audits, pharmacy and therapeutic services, infection control, utilization review, seclusion/restraint review, medical records, credentials, safety, and patients’/ individuals’ rights.

Develops and administers systems to evaluate the relative efficiency and effectiveness of various patterns and modes of service delivery for treatment programs.

Initiates studies to analyze trends or patterns of care, treatment interventions, practitioner performance, non-clinical support activities, community placements and readmissions to identify opportunities for improvement.

Chairs or participates at meetings of appropriate professional clinical and non-clinical staff and committees.

Performs the full range of supervisory duties. May participate in the performance of subordinates’ work consistent with operational or organizational requirements.

Performs related duties as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of community based mental health and substance abuse program administration and its interrelated systems.

Knowledge of the principles, practices, and methods of program planning, organization, and direction relative to QA/RM.

Knowledge of the principles and practices of healthcare administration.

Knowledge of JCAHO, Medicare, Medicaid, CMS and other national standards of patient/individual healthcare and treatment resources.

Ability to analyze and interpret healthcare organizational data.

Ability to analyze and interpret clinical and non-clinical healthcare practices.

Ability to establish and maintain effective working relationships.

Ability to communicate effectively orally.

Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING: One year of experience as a Quality Assurance/Risk Management Coordinator;

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Two years of experience as a Quality Assurance/Risk Management Specialist;

                                                                                                                            or

Four years of professional experience as a member of a multi-disciplinary treatment team in a public or private healthcare facility, and a bachelor’s degree;

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Four years of clinical experience in a human services agency, including three years of professional, evaluative, consultative, or supervisory work in a healthcare program, and a bachelor’s degree;

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An equivalent combination of experience and training which includes four years of professional, evaluative, consultative, or supervisory work in a healthcare program.