Quality Assurance & Improvement Manager - RN

Summary

Under the direction of the Director of Quality and Population Health, is responsible for oversight of clinical regulatory matters and facilitation of the accreditation process – readiness, onsite review, corrective action planning, monitoring, education, training and performance improvement – related to vaccine management, CLIA certification, and Patient-Centered Medical-Home programs; and manages clinical supply ordering and training for all practice locations. Creates an environment that fosters a just culture, patient and employee satisfaction and aids clinical teams in achieving quality outcomes that are in line with the mission, values and goals of The Jane Pauley Community Health Center (JPCHC). This individual is an integral member of the Quality and Population Health team.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Maintains and updates CLIA certification for JPCHC sites.

• Oversees and updates registration on clinical accounts with vendors such as McKesson, VFC, vaccine manufacturers.

• Maintains formulary for medications and clinical supplies; approves and sources new medications and clinical supplies.

• Maintains Safety Data Sheet Repository and provides staff training related to SDS

• Oversees compliance with VFC requirements for site enrollment and deactivation of sites.

• Serves as organizational contact for Accuvax.

• Oversees audits at each JPCHC site in accordance with organizational standards, and coordinates departmental level performance improvement in collaboration with practice managers

• Provides reports to the leadership team, Risk Management and Quality, Safety, and Population Health Committees as needed

• Oversees vaccines utilization and periodic audit through report reconciliation between CHIRP and EMR.

• Participates and assists in the development of clinical policies, protocols, and procedures

• Coordinates PCMH applications and renewals for applicable sites

• Ensures compliance with PCMH standards and manages performance improvement activities related to PCMH certifications

• Leads process improvement activities related the quality and safety of patient care. These opportunities may be identified through event reporting, quality planning, or stakeholder feedback.

• Functions as a resource for infection control processes across all JPCHC sites.

• Oversee the performance and continual learning of vaccine and supply management of clinical support staff in coordination and collaboration with practice management.

• Manages and coordinates training programs for staff related to vaccine management, clinical supplies and equipment, CLIA Waived Testing, and infection control.

• Works with health center leadership to create efficient practice clinical services for vaccine and supply management, implement process improvements and excellence in patient care.

• Maintains current experience with clinical workflows and best practices.

Supervisory Responsibilities

• This position will act as a direct supervisor as assigned.

Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• Valid and unrestricted RN License in Indiana

• BSN required; MSN preferred.

• Minimum of three (3) to five (5) years’ experience as a supervisor or charge nurse in ambulatory care setting such as pediatric or family medicine, preferred.

• 1 year in a Patient-Centered Medical Home clinical setting or knowledge of the Patient-Centered Medical Home initiative preferred

• Ability to travel up to 75% of the time to practice locations

• Attention to detail, organization, and follow-up skills

• Knowledge of project management or Lean Six Sigma

• Self-disciplined, proactive, passionate, innovative, team-oriented.

• Strong oral and written communication skills.

• Demonstrates sound judgment, decision-making and problem-solving skills.

• Able to maintain confidentiality with all aspects of information in accordance with practice, State and Federal regulations.

Computer Skills

To perform this job successfully, an individual should have proficient computer skills, including

• Microsoft Office (specifically Word, PowerPoint and Excel)

• Electronic Medical and Health records, OCHIN EPIC preferred

• EPIC Slicer-Dicer

• Azara

• and the ability to operate other web-based applications such as CHIRP, AccuVax, and NCQA Q-Pass

Certificates, Licenses, Registrations

• American Heart Association Basic Life Support Provider certificate

• Indiana Registered Nurse license

• Certified Professional in Healthcare Quality (achieve within 2 years of hire if not certified at time of hire)

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear.

• The employee is occasionally required to stand and walk.

• The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision and ability to adjust focus.

Work Environment The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.