Job Summary:

In addition to the responsibilities listed above, this position is also responsible for maintaining quality improvement systems, escalating issues as necessary; ensuring that the organization meets the standards established by regulatory agencies and accreditation organizations and meets public expectations with minimal guidance; validating the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners; utilizing systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education with general guidance; leveraging standardized and established processes for review and approval of medical staff or provider staff Bylaws, Rules and Regulations and amendments; and monitoring oversight systems of all contracted entities including but not limited to the Permanente Medical Groups.

Essential Responsibilities:

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.

• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.

• Applies expertise for clinical quality improvement processes and regulations within assigned area practitioners and Quality Specialists by: maintaining awareness of current internal policies and relevant external regulations; participating on committees, projects to provide guidance and general recommendations on the enforcement, development of policies or procedures of regulations and auditing processes; leveraging collaborative, results oriented partnerships with practitioners across clinical and administrative roles to ensure compliance with regulations and improve patient safety, reporting accuracy, and health outcomes; and preparing materials for educational programs to raise awareness for regulation requirement, internal concerns, and system/database usage.

• Facilitates quality of care complaints and the review process by: making recommendations based on available evidence and assessing if the quality of care complaint can be substantiated; preparing and reviewing all documentation, records, chart reviews, staffing reviews, and the information requested; and following up with the appropriate individuals/teams to ensure the quality of care concern is referred to the right team and monitoring any additional updates related to the specific concern and taking any follow-up action needed.

• Assists with infection prevention and control programs to improve employee and patient safety by: assisting with epidemiological research as a part of prevention and surveillance, and outbreak management as requested; and adhering to outbreak protocols and assisting in all outbreak containment efforts within the area of focus.

• Conducts 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, patient satisfaction surveys, and auditing surveys; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to near misses and good catches in order to identify areas of improvement; utilizing health outcome analysis to continuously monitor oversight effectiveness; and assisting with escalating high-risk issues and trends to appropriate entity for resolutions.

• Assists with patient safety and satisfaction programs and initiatives by: identifying safety hazards, accidents, incidents, threats, and significant events promptly and following up accordingly; and assisting in the delivery of patient outcomes to improve or implement safer patient practices and services and seamless transition of care.

• Assists in the development of new clinical quality improvement and quality improvement programs by: facilitating meetings with practicians, teams, and departments to gather information for the development of guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, ongoing monitoring of program performance, and peer/department review groups; developing an understanding and staying abreast of a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and supporting the integration of continuous learning orientation into programs to assist with oversight, development, and improvement initiatives.

• Assists in the collection and entry of data into systems, procedures, and forms to improve data management programs and utilizes data from internal and external sources to monitor and evaluate quality improvement initiatives by: conducting descriptive and inferential statistical analysis for routine quality improvement evaluations; gathering data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and preparing reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) into specified formats.

• Conducts regulatory audits and surveys by: assisting with onsite visits and evaluations and supporting the coordination with the relevant department as directed; preparing requested audit documentation, information, reports, and tools throughout the auditing process; and communicating and coordinating with the supervisor and relevant departments on the status of survey completion and any follow-up actions as required for auditing surveys.

• Supports the evaluation of the cost effectiveness, practicality, appropriateness, and equal application of care to diverse patients by: preparing forms and materials to be reviewed by the supervisor for case reviews; gathering information to support the development of the standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care; gathering information related to current patient treatment plans to ensure patient needs are met in a timely manner; facilitating discussions between practitioners, staff, and patients to identify population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others; and preparing reports of previous patient cases to identify areas of improvement for length of stay, type of treatment, time of treatment, and barriers to treatment (e.g., language barriers and mobility accessibility) as requested.

  Minimum Qualifications:

• Minimum one (1) year of experience with databases and spreadsheets.

• Bachelors degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND Minimum one (1) year of health care experience or a directly related field OR Minimum four (4) years of experience in health care or a directly related field.

  Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): N/A

COMPANY: KAISER

TITLE: Quality and Safety Oversight Specialist III, Health Plan and Hospital, Non RN

LOCATION: Fresno, California

REQNUMBER: 1305218

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.