Job opening in a 100 bed hospital located in Southern TN, for Director of Quality, Risk and Performance Improvement to join their team. The Director will assist in overseeing the UM dept to ensure quality care, however, those directors (Case Management and Infection Control) do report to the CNO.
Directs the Utilization Management Department activities and resources to achieve departmental and organizational objectives.
Reports to Chief Nursing Officer
We are looking for:
- Strong candidate who is knowledgeable in TJC, CMS and CLEA standards.
- Someone who can come in and be the CEO of their department.
- Someone who is capable of successfully running the department with minimal support.
- Someone who is willing to be a team player and foster an environment of professional growth
- Oversees all Risk Management activities including managing claims against the facility; interfacing with defense counsel; interacting with patients, medical staff and hospital staff to resolve complaints; administering the risk management program on a day to day basis; managing and analyzing the risk management data; overseeing the patient safety programs in order to maintain an environment that optimizes patient safety and reduces the likelihood of medical/health errors.
- Oversees all quality management activities including: performance improvement, quality review, Joint Commission readiness, and core measures management.
- Participates in hospital and medical staff committees as required.
- Establishes policies and procedures as needed.
- Maintains oversight responsibility for the review of all usage patterns for medical necessity and appropriation of care against screening criteria.
- Develops and implements Utilization Management goals, plans and standards consistent with the clinical, administrative, legal and ethical requirements of the organization.
- Monitor discharge process and ensuring clinical documentation is done accurately.
- Develops and implements policies and procedures to support the Utilization Management processes as outlined in the Utilization Management Plan.
- Demonstrates a high degree of accuracy and attention to detail to optimize the cost-effective delivery of care.
- Directs and evaluates departmental operations, including patient care delivery, information technologies, service level determination, and complaint management, to achieve performance and quality control objectives.
- Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
- Prepares, monitors, and evaluates departmental budgets, and ensures that the department operates in compliance with allocating funding.
- Coordinates and directs internal/external audits.
- Creates and fosters an environment that encourages personal growth.
- Integrates evidence-based practices into operations and clinical protocols.
- Assures quality of care by adhering to established best-practices and standards; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following hospital and philosophies and standards of care set by the Tennessee Board of Nursing, and other governing agencies
- Demonstrates knowledge of current standards related to The Joint Commission, Medicare, and Medicaid in addition to changes in guidelines and methodology for managed care programs.
Bachelor’s degree in Nursing required
Five years of Utilization Management experience preferred
Three years of supervising experience preferred
Must possess thorough understanding of the patient care process, TJC standards, Core Measures and Performance Improvement Process.
Must be able to communicate effectively with patients, physicians, hospital personnel, and accreditation entities.
Basic Life Support (BLS) required
Healthcare Risk Management Certification preferred.
Certified Professional in Patient Safety certification required within 12 months of hire.
Current and active Registered Nurse license in the State of Tennessee.
This city is home to a robust educational scene, including eight elementary schools, one middle school, three high schools, private education opportunities and college campuses. The county is also home to a thriving Amish community, and the town is recognized as the Birthplace of Southern Gospel Music. Festivals and celebrations abound throughout the year, including the Summertown Bluegrass Festivals and David Crockett Days. Nashville’s entertainment and cultural activities lie just 80 miles north. The local State Park features campgrounds, LEED-certified vacation cabins, an Olympic-size swimming pool and modern bathhouse, a children’s wading pool, a paved bicycle trail, hiking, volleyball, tennis and a restaurant. A large lake offers 325 acres of fishing, row boating, canoeing and pedal boating. And golfers can tee off at one of three unique courses in the county.
Huntsville, AL (65)
Nashville, TN (80)
Chattanooga, TN (140)
Memphis, TN (170)
Competitive Salary Range!
Executive & Management Recruitment Services
(415) 770-1200 – call/text