Peer & Dept Review, Quality & Safety Improvement Consultant IV, Clinical Quality Consulting (KFH/HP)

In addition to the responsibilities listed above, this position is also responsible for providing consultation and education related to clinical quality and patient safety, accreditation, regulatory and licensing (AR&L), risk management, and infection prevention and control; contributing to the evaluation, design, and development of evidence-based guidelines, principles, and/or programs related to area of work as well as facilitating implementation efforts to reduce variation in clinical practice and optimize patient outcomes; assisting with the collection, analysis, report development, and presentation of clinical data for a variety of users including for state, federal, and local agencies; helping to provide education regarding the interpretation of compliance methods when preparing for regulatory reviews, the interpretation of regulatory requirements, and regional project goals; monitoring, reporting, and developing mitigation plans for all occurrences which may lead to medical center liability; supporting the medical centers continuous survey readiness program to maintain compliance with regulatory standards; and serving as a liaison with applicable government agencies, regulatory agencies, and other organizations.

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Conducts data extraction, analyses, and presentations to support quality improvement efforts by: conducting statistical analysis to determine the reliability and confidence intervals for quality improvement evaluations and special projects; creating charts, graphs, and narrative summaries of improvements utilizing multiple data reporting systems; presenting quality improvement metric reports at the individual and team level to demonstrate improvements and effectiveness of quality improvement programs into specified formats; and documenting and analyzing trends, potential errors, and other analysis and reporting finds to the supervisors.
• Facilitates quality improvement and improvement risk management efforts by: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, member satisfaction surveys, and auditing surveys; ensuring process improvements are compliant with established internal and external regulation requirements at the local level; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement; and exercising independent judgment to escalate high-risk issues and trends to appropriate entity for resolutions.
• Develops and utilizes quality improvement performance metrics by: developing performance metrics, standards, and methods to establish improvement success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure development of cohesive and reachable metrics are practical and approved for assigned departments; and facilitating the collection of metric data from workflows and projects by utilizing sound methodology.
• Facilitates the development of quality improvement initiatives by: implementing methods and tools to develop stakeholders capabilities for process improvements; integrating the use of data-driven improvement principles, tools, and problem-solving methods, including Lean/Six-Sigma concepts and techniques using quality improvement metrics; and developing and updating milestones, detailed workplans, and documentation practices in order to create a clear, logical, and realistic plan.
• Serves as the subject matter expert for quality improvement processes and regulations within assigned departments by: learning current internal policies and external regulations; participating on committees, projects to propose a course of action on the enforcement, development of policies or procedures of regulations and auditing processes; fostering collaborative, results oriented partnerships to ensure compliance with regulations and improve patient safety, maintain the KP safety culture, reporting accuracy, and health outcomes; delivering educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage; and anticipating issues, weigh practical considerations in addressing issues and seek input from engagement manager/sponsor to resolve.
• Delivers stakeholder development and quality performance review efforts by: conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines, and takes a systematic approach to quality improvement; identifying performance areas of improvement for stakeholders and provides feedback and coaching as needed; and delivering and assisting in the development training and educational programs related to process improvement for quality improvement programs for stakeholders at the team level.

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

• Clinical Quality Expertise
• Agile Methodologies
• Applied Data Analysis
• Compliance Management
• Development Planning
• Health Care Compliance
• Health Care Quality Standards
• Negotiation
• Process Mapping
• Project Management
• Quality Improvement
• Risk Assessment
• Risk Management

• Minimum one (1) year of experience in a leadership role with or without direct reports.
• Minimum two (2) years of experience with databases and spreadsheets or continuous quality improvement (CQI) tools.
• Minimum three (3) years of experience in a clinical setting, health care administration, or a directly related field.
• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum four (4) years of experience in quality, performance improvement, customer service, or a directly related field OR Minimum seven (7) years of experience in heath care quality assurance/improvement or a directly related field.

• Registered Nurse License (California)

• Master's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field.
• Health care clinical license from the practicing/applicable state (e.g., Registered Pharmacist (RPh), Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker).