POSITION SUMMARY/RESPONSIBILITIES

The Director provides expertise and directs the quality and clinical outcomes program to improve quality of patient care, meet regulatory reporting requirements, and coordinate and analyze results of quality improvement activities across the organization. Is the subject matter expert and oversees quality improvement activities to include Core Measures, Patient Safety Indicators, Potentially Preventable Complications, Corrective Action Plans, Peer/Case Review and CMS quality programs. Oversees the daily department operations and hires, trains, mentors and supervises department staff.

EDUCATION/EXPERIENCE

Bachelor degree in nursing and 7 years experience in a clinical setting is required. Must possess a current RN license from the Board of Nurse Examiners of the State of Texas. Master's degree in nursing, healthcare administration, business or similar discipline preferred. CPHQ certification preferred. Significant experience in health care quality improvement is also required. Thorough knowledge of various regulatory reporting standards, health care regulations, policy formulation, quality management, and process improvement is required. Knowledge of analytical and investigative techniques sufficient to identify current methodologies and conduct evaluations of the effectiveness of the results is required. Candidate must have a thorough understanding of CMS and JC requirements. Knowledge and experience in data analysis is required. Good analytical and communications skills are required. Three years progressive management experience is preferred.