Vice President, Quality Management

The posting

The Vice President of Quality Management is responsible for the strategic development and implementation of Saint Joseph's Medical Center's Patient Safety and Quality Program. The quality program includes initiatives to maximize quality, improve patient safety, and mitigate risk.

In collaboration with the SJMC Senior Leadership Team, the Vice President of Quality and Risk functions as the Patient Safety Officer to develop and prioritize organizational quality initiatives to ensure that patient safety is integrated into all initiatives, whether clinical, operational, or related to improving the patient experience.

This position coordinates external regulatory surveys and data reporting to ensure organizational performance meets desired objectives.

DUTIES AND RESPONSIBILITIES

• Serves as Patient Safety Officer.
• Promotes organizational understanding, communication, and coordination of Quality Management programs through the established quality committee structure, creating targeted workgroups and ensuring state goals and objectives are met.
• Maintains and establishes indicators for monitoring and evaluating the quality and appropriateness of care and services.
• Assesses continuous improvement in monitored indicator activities.
• Monitors member satisfaction and directs initiatives for improvement while evaluating the effectiveness of interventions across the continuum of care.
• Serves as the primary contact for regulatory agencies and maintains awareness of regulatory requirements and updates.
• Develops and implements programs to improve safety and decrease risk.
• Provides primary support to the Risk Management Program, including claims management, insurance management, and regulatory reporting.
• Provides oversight of the Corporate Compliance Program, ensuring adherence to federal and state compliance requirements.
• Serves as a role model and leader to colleagues and staff throughout the organization.
• Represents the organization internally and externally as required.

RISK MANAGEMENT

1. Works with leadership in organizational operations, quality, etc.
2. Serves on the Audit Committee, Quality Assessment and Performance Improvement Subcommittee, Performance Improvement Safety Council, and Radiation Safety Committee.
3. Has authority to retain, direct, and approve compensation of defense counsel.
4. Conducts analyses to identify patterns that could result in compensable events.
5. Responds to the needs of the Medical Staff and department heads regarding Risk Management.
6. Develops and implements facility policies and procedures affecting liability exposure.
7. Selects and utilizes consulting services, brokers, carriers, and related resources.
8. Provides summary reports for incidents, claims, reserves, and claim payments.
9. Complies with state and federal laws, regulations, and reporting requirements related to patient care, patient safety, and investigations.
10. Reviews contracts and agreements for compliance with Saint Joseph's Medical Center insurance specifications.
11. Works with defense counsel by providing required information, data, materials, and policies for active and potential claims.
12. Reports and prepares written reports for the New York Patient Occurrence Reporting and Tracking System (NYPORTS).
13. Prepares reports and provides NYPORTS data for the Quality Assessment and Performance Improvement Subcommittee.
14. Reviews occurrence reports and prepares summaries for the Environment of Care and Audit Committees.
15. Provides in-service education for facility staff.
16. Reviews medical records for areas of potential liability exposure.
17. Reviews occurrence reports and other reporting tools for patterns and trends that could result in compensable events.
18. Manages the Institutional Review Board (IRB) as it relates to facility policies and legal requirements.
19. Develops and implements facility policies and procedures to meet legal requirements.
20. Procures outside loss prevention services.

CLAIMS MANAGEMENT

1. Manages reporting procedures, system maintenance, claim investigations, reserve establishment, legal counsel selection, claimant communications, settlements, and actuarial services.
2. Ensures compliance with Medicare and Medicaid regulations related to claim settlements.
3. Manages federal Section 111 SCHIP reporting for Medicare Secondary Payer requirements.
4. Reports claims information to the Audit Committee.
5. Directs investigative activities.
6. Directs claims handling and defense preparation with attorneys and insurers.
7. Projects future costs related to losses, insurance, and other risk management activities.
8. Manages and resolves claims within the self-insured program in collaboration with the Chief Financial Officer, President & CEO, and Board of Trustees when applicable.

RISK FINANCING

1. Maintains familiarity with insurance markets.
2. Plans, coordinates, and administers a comprehensive insurance program, including purchasing, consulting, self-insurance administration, and claims handling (excluding Workers' Compensation).
3. Prepares data for brokers and carriers and manages insurance claims through settlement.
4. Prepares specifications for competitive bidding and negotiates insurance coverage, premiums, and services.
5. Recommends changes in risk control and financing based on operational changes.
6. Reports projected insurance costs to the Finance Department.

CORPORATE COMPLIANCE

1. Logs corporate compliance issues.
2. Maintains records of in-service attendance and compliance issues.
3. Prepares reports for regulatory agencies, the Board of Trustees, and others as required.
4. Monitors changes in compliance laws and regulations and reports significant changes to management.
5. Provides compliance education to hospital staff.
6. Serves as liaison between legal counsel and auditors.
7. Chairs the Compliance Committee.
8. Provides education to the Compliance Committee.
9. Coordinates reports presented to the Compliance Committee.
10. Assists in developing the SJMC Audit Log for the Compliance Committee and Audit Committee.
11. Participates in the GNYHA Compliance Group to remain current on healthcare compliance issues.

KEY RESPONSIBILITY AREAS

• Clinical Risk Management
• Loss Prevention
• Claims Management
• Risk Financing
• Corporate Compliance

MISSION

The above duties and responsibilities reflect the Mission of Saint Joseph's Medical Center and Nursing Home.

Saint Joseph's is a Catholic healthcare facility sponsored by the Sisters of Charity of St. Vincent de Paul of New York. With a commitment to the community, the organization strives for excellence in healthcare within an atmosphere of support, dignity, respect, and compassion.

CORPORATE COMPLIANCE

Employees must read and understand the comprehensive Code of Conduct and carry out the legal and ethical requirements necessary to fulfill their obligations to Saint Joseph's Medical Center while adhering to all federal and state requirements.

PHYSICAL DEMANDS

• Walking
• Writing
• Bending
• Good general health
• Occasional lifting of light objects

QUALIFICATIONS / EDUCATION

• MHA; MBA; MPA; and RN
• Clinical background required to conduct root cause analyses and evaluate clinical operations
• Master's degree in a healthcare-related field
• Specialty certification preferred
• Progressive leadership experience

EXPERIENCE

1. Minimum of five (5) years of experience in a hospital setting.
2. Experience with insurance applications and purchasing.
3. Experience with network computer systems.
4. Familiarity with clinical settings.
5. Expertise in management and operational assessment.

SPECIAL SKILLS

1. Strong written and verbal communication skills.
2. Moderate computer skills.

LICENSES / REGISTRATIONS / CERTIFICATIONS

• Registered Professional Nurse (NYS)