09/01/1993 43393

QUALITY ASSURANCE/RISK MANAGEMENT SPECIALIST

DEFINITION: This is professional staff work specializing in the quality assurance/risk management monitoring and evaluation of a facility wide system of patient care services, ensuring that services meet regulatory standards at a state mental hospital or restoration center.

An employee in this class consults and collaborates with interdisciplinary clinical and nonclinical support staff in the monitoring and evaluation of the quality assurance and risk management program activities at a state mental hospital or restoration center. Work involves interpreting facility, Departmental, state and federal policies, regulations and legislation for quality of patient care services; analyzing, evaluating and summarizing quality assurance and risk management data; and identifying possible liability problems and issues of noncompliance with regulatory requirements. Work includes monitoring, examining and evaluating records of patient care, incident reports, medication reports, third party payor reports, administrative policies and practices, and practitioner credentials; investigating staff complaints and patient abuse reports; inspecting the physical plant for compliance with life safety code and sanitation requirements; identification of therapeutic environment deficiencies; and tracking progress of problem solving and monitoring activities for the implementation of actions to correct operating deficiencies. Important aspects of the work are conducting in house surveys; recommending possible solutions to problems and development of methods to prevent or correct potential liability and/or operating deficiencies and cooperating with independent third party certifying and accreditation surveying agencies. Work is performed under the general supervision of the Quality Assurance/Risk Management Director, Quality Assurance/Risk Management Coordinator or other Administrative Supervisor. Work is reviewed for conformance with established criteria, standards and procedures as set forth in the facility's quality assurance and risk management plan and Departmental, state and federal rules, regulations, policies and procedures through conferences, reports and evaluation of results achieved.

EXAMPLES OF WORK: Interprets facility, Departmental, state and federal policies, regulations and legislation for quality of patient care services for facility staff and vendor services and provides input for the development of the facility's comprehensive quality assurance/risk management plan.

Consults and collaborates with interdisciplinary clinical and nonclinical support staff engaged in monitoring and evaluating quality assurance and risk management program activities to assure the appropriateness and quality of patient care provided meets the regulatory requirements.

Analyzes and evaluates patient/staff incident reports, records of patient care and nutrition needs, medication reports, third party payor reports, administrative policies and practices and practitioner credentials and identifies potential liability problems and issues of noncompliance with regulatory requirements.

Participates in house surveys with interdisciplinary clinical and nonclinical administrative and support services staff to identify potential problem areas, recommends methods and actions to prevent and/or to correct staffing and/or operating deficiencies, and monitors follow-up activity reports to ensure timely and appropriate actions are taken to minimize and/or to prevent problem reoccurrences.

Accomplishes and coordinates quality assurance/risk management monitoring and evaluation studies with Medical Records Specialists, Infection Control and Utilization Review Practitioner[s], clinical interdisciplinary staff or others to identify patterns and trends of care and treatment planning, monitors and evaluates treatment activities leading to successful placement in the community; and monitors and evaluates readmission information for use in recommending changes in treatment planning.

Investigates reported problems related to hospital systems and operations, safety of patients and staff, injury reports and patient complaints and abuse; recommends appropriate actions; provides guidance and assistance to facility staff to correct deficiencies; and prepares written and oral reports on problem/deficiency resolution.

Participates in the organization and coordination of independent third party surveys conducted by certifying and accrediting agencies for compliance with State and Federal regulations and legislation and DPW standards by completing required pre-survey forms and assembling documentation and records for review by surveyors, and accompanying them on the on-site review.

Provides input to and assists in the implementation and monitoring of action plans to minimize liability problems and to correct deficiencies identified by independent survey teams.

Prepares reports and maintains files and records of quality assurance/risk management monitoring and evaluation activities and completed studies.

Performs related duties as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of federal and state regulations, rules, policies and procedures relative to the quality assurance/risk management program.

Knowledge of medical and psychiatric terminology, appropriate levels of patient care and treatment, health and nutrition care delivery systems and practitioners' credential requirements.

Knowledge of principles and practices of health care administration pertaining to quality assurance/risk management patient care services.

Ability to interpret policies, procedures, rules and regulations applicable to the quality assurance/risk management program.

Ability to interpret, analyze, and evaluate nonclinical and clinical care practices, including patient care, treatment and nutrition records, medical records and health services management records to determine the appropriateness and quality of care and services provided for patients.

Ability to collect and record information and to identify potential and/or actual liability problems and issues of noncompliance with regulatory requirements.

Ability to establish and maintain effective working relationships with interdisciplinary clinical and nonclinical administrative and support services staff engaged in quality assurance/risk management program activities.

Ability to provide guidance and technical assistance and to instruct facility staff on the governing quality assurance/risk management regulation requirements and to recommend and assist them in correcting operating deficiencies.

Ability to prepare reports and to express ideas clearly and concisely, orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: Two years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor's degree;

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Two years of clinical experience in an human services agency, including one year of administrative, evaluative, or consultative experience in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field;

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Any equivalent combination of experience and training.