Market Director Quality

CommonSpirit Health

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U. S. , from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

Responsibilities

Responsibility for developing and implementing patient safety initiatives, assuring success of continuous quality enhancement initiatives inter-and intra- departmentally and Oversees an effective infection control/prevention program. This role Responsible for the appropriate use of quality tools (root cause analysis, failure mode effects analysis, histograms, fish bones, cause maps statistical process control and other statistics) to help problem solve and benchmark appropriately. Assures compliance with regulatory standards and Ensures they are continually upheld. Will be responsible for the planning, development, implementation administration, evaluation and continual enhancement of policies, procedures and practices for each functional area.
Develop, implement and continually enhance programs to proactively assess and monitor compliance by all departments and services with all applicable regulatory requirements.
Develop and facilitate multidisciplinary surveys of all departments and services on a random basis to monitor and assess for continued compliance.
Coordinate and facilitate any announced or unannounced surveys.
Respond to requests by the leadership team, executives for follow up on letters of complaint from regulatory or accrediting agencies.

Quality
Develop, implement and continually enhance programs to proactively assess, monitor and continually enhance quality standards.
Ensure that policies and procedures are current and meet all current laws, regulations and standards of care; monitor dates of review and revision; revise as appropriate.
Establish and continually enhance the Quality Council, serving as leader; serve as a member of quality committees as required.
Coordinate environment of care rounds.
Serve as the liaison to the Chief Quality Officer (CQO).

Infection Control
Collaborate with the Infection Control Specialist and appropriate Health System staff to develop and implement infection control programs and practices.
Assist the Infection Control department in reviewing departmental and infection control policies, assisting in the development and revision to ensure that current practice meets professional and regulatory standards.

Professional Development

Maintain current knowledge and expertise through professional organizations and relationships with others in area of practice.

Fiscal Management
Develop, implement and appropriately manage budgets to ensure necessary funding for operational and capital needs.
Pursue creative strategies to lower costs while maintaining or enhancing quality

Qualifications

Required:Bachelor’s Degree in related discipline; Master’s Degree strongly preferred

Registered Nurse, clinical licensure preferred.

Working knowledge of National Quality Forum (NQF), Agency for Healthcare Research and Quality (AHRQ), Institutes for Healthcare Improvement (IHI) safety indicators, serious reporting events, safe medical practices, and Centers for Medicare and Medicaid Services

(CMS) quality measures helpful

Preferred: Nationally recognized quality-related certification (CPHQ, PMP, CJCP, CPPS)

Working knowledge of National Quality Forum (NQF), Agency for Healthcare Research and Quality (AHRQ), Institutes for Healthcare Improvement (IHI) safety indicators, serious reporting events, safe medical practices, and Centers for Medicare and Medicaid Services

(CMS) quality measures helpful. Experience with Cerner, Allscripts, Meditech and other EHR software systems a plus. Strong Information Technology – informatics knowledge a plus.

Knowledge in Infection Control.

Equal Opportunity
CommonSpirit Health is an Equal Opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.
External hires must pass a post offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA).
CommonSpirit Health participates in E-verify.
Seniority Level
Director
Industry
Non-profit Organization Management
Health, Wellness & Fitness
Hospital & Health Care
Employment Type
Full-time
Job Functions