POSITION SUMMARY RESPONSIBILITIES

Through direct supervision from the Executive Director, Quality Outcomes and Executive Director, Risk Management, supports health system and community hospital leadership through the implementation and management of the quality improvement and risk programs designated to enhance the quality of patient care, reduce injuries and minimize claims as well as coordinate and analyze results of quality improvement activities for community hospital service departments. Acts as the subject matter expert regarding quality and risk management as it relates to University Health policies and procedures, Texas state regulations, and CMS federal regulations. Coordinates process improvement activities across all departments.

EDUCATION/EXPERIENCE

Registered Nurse (RN) currently licensed in Texas with a BS degree in nursing or other health care related field; BSN preferred. Master's degree in nursing or other healthcare related field preferred. A minimum of five years' recent experience in acute healthcare is required. Three to five years' experience in comprehensive healthcare quality improvement & risk management is required. Candidate must have a thorough understanding of publicly reported reputation/penalty program requirements to include, but not limited to CMS, AHRQ, NCQA, Leapfrog, Lown Institute, US News & World Report, MIPS/TIPS, and TJC. Knowledge and experience in data analysis is required. Good analytical and communications skills are required.

LICENSURE/CERTIFICATION

Current licensure from the Texas Board of Nursing is required. Certified Professional in Healthcare Quality (CPHQ) certification and / or Certified Professional in Health care Risk Management (CPHRM) certification is preferred.