11/18/1994 43392

QUALITY ASSURANCE/RISK MANAGEMENT COORDINATOR

DEFINITION: This is professional and administrative work coordinating a facility-wide system for monitoring and evaluating the appropriateness and quality of patient or resident care services at a state mental hospital, restoration center or state veterans' home long-term care facility.

An employee in this class coordinates and evaluates an integrated interdisciplinary program for the ongoing monitoring and evaluation of the comprehensive quality assurance and risk management program activities. Work involves participating in the Quality Assurance/Risk Management Committee meetings; interpreting federal, state, departmental and facility policies, regulations and legislation for quality of patient or resident care services; and participating in the development and implementation of methods of monitoring and evaluating practices and practitioner credentials and performance in the delivery of clinical services and nonclinical support activities. Work includes developing and coordinating the monitoring and evaluation studies and criteria to identify and minimize liability problems and to measure the quality and appropriateness of patient or resident care services.

The employee provides guidance and technical assistance and collaborates with interdisciplinary clinical and nonclinical support staff in coordinating independent third-party surveys conducted by certifying and accrediting agencies and participates in developing, implementing and monitoring action plans to minimize liability problems and to correct deficiencies. Supervision is exercised over a small staff of professional, technical and clerical employees. The employee is expected to exercise initiative and independent judgment in assuring the facility's quality assurance/risk management program meets DPW, Department of Health, governmental auditing, Medicare, Medicaid, JCAHO, HCFA and/or U.S. Department of Veterans Affairs standards as they pertain to state facilities. Work is performed under the general supervision of the facility administrator or Commandant or the Quality Assurance/Risk Management Committee Chairperson. Work is reviewed for conformance with established criteria, standards and procedures as set forth in the facility's quality assurance/risk management program plan and department, state and federal policies, rules, regulations and legislation through conferences, reports and evaluation of results achieved.

EXAMPLES OF WORK: Participates in the development and implementation of systems for reviewing and monitoring operational structures, plans, policies, procedures and timetables for quality assurance/risk management activities to be implemented by facility committees and clinical and nonclinical administrative and support services departments.

Participates at Quality Assurance/Risk Management Committee meetings with facility leadership staff, department heads, committee chairpersons and other clinical and nonclinical staff to facilitate collaboration and coordination of clinical practices, training, programming and administrative issues to assure compliance with DPW, Department of Health, Medicaid, Medicare, JCAHO, HCFA and/or U.S. Department of Veterans Affairs standards, as they pertain to state facilities, for patient or resident health, care and safety.

Implements and coordinates the facility's integrated interdisciplinary program plan for the ongoing monitoring of the comprehensive quality assurance/risk management program activities and evaluates the appropriateness and quality of patient or resident care services at a state mental hospital, restoration center or state veterans' home long-term care facility.

Provides guidance and technical assistance to nonclinical and clinical interdisciplinary care and treatment staff and coordinates an ongoing facility- wide monitoring system of service delivery to evaluate the appropriateness and quality of care; to minimize liability; and to insure optimum quality care to patients or residents by coordinating the review of incident reports, medication reports, third-party payor reports; investigating problems related to hospital systems and services, safety of patients or residents and staff, complaints and public relations inquiries; and recommending appropriate corrective action.

Serves as an agent of the facility administrator or Commandant for interpreting federal and state requirements and in recommending the establishment of priorities for quality assurance/risk management objectives and to design and implement actions to identify and minimize liability problems and to correct deficiencies.

Conducts training programs for clinical, administrative and support staff concerning the quality assurance/risk management program and its requirements.

Collaborates with nonclinical and clinical interdisciplinary staff in coordinating independent third-party surveys conducted by certifying and accrediting agencies for compliance with state and federal regulations, legislation and DPW, Department of Health and/or U.S. Department of Veterans Affairs' standards, as they pertain to state facilities.

Coordinates, prepares, implements and monitors action plans to minimize liability problems and to correct deficiencies identified by independent survey agencies.

Monitors and evaluates the quality assurance/risk management activities of medical staff and facility committees, such as medical staff audits, pharmacy and therapeutic reviews, infection control, utilization review, seclusion/restraint review, medical records, credentials, safety and patients' or residents' rights.

Supervises the work of a small staff of professional, technical and clerical employees, as assigned to quality assurance/risk management functions.

Identifies quality assurance/risk management problem areas and coordinates information collection, study and problem-solving with facility leadership staff for corrective action.

Assists and supports clinical or nonclinical department directors and supervisors in the development and implementation of specific quality assurance/risk management program goals in a manner consistent with modern principles of health services management and accrediting and certifying agency standards for quality patient or resident care.

Monitors and coordinates systems for ongoing evaluation of the appropriateness and quality of patient or resident care and treatment programs to determine the relative efficiency and effectiveness of various patterns and modes of service delivery.

Conducts studies and collects data for analysis of trends and/or patterns of care, treatment interventions, practitioner performance, successful community placement activities and readmission information to identify successful programs, opportunities for improvement and to minimize problems.

Performs related duties as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of facility administration and its interrelated systems within the scope of the particular facility.

Knowledge of the principles, practices and methods of program planning, organization, development, implementation and coordination relative to quality assurance and risk management.

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

Knowledge of DPW, Department of Health, JCAHO, Medicare, U.S. Department of Veterans Affairs and/or other national and state standards relating to standards of patient or resident care.

Ability to consult with facility leadership staff, department heads, quality assurance/risk management committee members, clinical/nonclinical support staff on quality assurance/risk management requirements to develop the facility's quality assurance/risk management plan.

Ability to analyze and evaluate critical care practices and nonclinical support activities, resource planning and development and health care organizational issues/data in order to coordinate quality assurance/risk management operational and monitoring procedures for improved service delivery or problem resolution.

Ability to provide consultation and technical assistance to clinical and nonclinical staff on such regulatory requirements as JCAHO, Medicare, Medicaid, Department of Public Welfare, Department of Health and U. S. Department of Veterans Affairs.

Ability to establish and maintain effective working relationships with professional clinical and nonclinical interdisciplinary and technical staff, the general public and others.

Ability to supervise and coordinate the work of nonclinical and clinical interdisciplinary staff activities for monitoring and evaluating the quality and appropriateness of patient or resident care services.

Ability to study, evaluate and interpret a quality assurance/risk management program and to make recommendations for improvement.

Ability to understand and apply research and evaluation methodologies and automated data collection and retrieval systems applications to quality assurance/risk management.

Ability to prepare and present findings and to provide support and guidance concerning required corrective actions.

Ability to express ideas clearly and concisely, orally and in writing, and to speak effectively in public.

MINIMUM EXPERIENCE AND TRAINING: One year as a Quality Assurance/Risk Management Specialist;

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Three 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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Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work 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.