Clinical Research Quality Assurance-CAPA Lead

Description:
In addition to the responsibilities listed above, this position is also responsible for partnering with the Board of Directors and driving the oversight of systems designed to monitor and ensure the quality care and services are provided at a comparable level to all members and patients across the continuum of care; serving as a subject matter expert on quality improvement systems; providing recommendations and guidance on issues related to the organization meeting the standards established by regulatory agencies and accreditation organizations and meeting public expectations; analyzing and verifying the integrity of systems related to the selection, credentialing and competence of physicians and other health care practitioners; evaluating and ensuring the integrity of systems for granting or terminating clinical privileges, professional staff or medical staff or clinical staff membership, proctoring and continuing education; facilitating the review and approval of medical staff or provider staff Bylaws, Rules and Regulations and amendments; and serving as a subject matter expert on the oversight of systems of all contracted entities including but not limited to the Permanente Medical Groups.

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides actionable feedback to others, including upward feedback to leadership; influences, mentors, and coaches team members. Practices self-leadership; creates, evaluates, and responds to the strengths and weaknesses of self and unit or team members. Leads the adaptation to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Fosters open dialogue amongst team members.


• Drives the execution of multiple work streams by identifying member and operational needs; translates business strategy into actionable business requirements; develops and updates new procedures and policies. Gains cross-functional support for objectives and priorities; determines and carries out processes and methodologies; solves highly complex issues; escalates and resolves issues as appropriate; sets standards and measures progress. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; influences the completion of project tasks by others.


• Serves as the technical subject matter expert for clinical quality improvement processes and regulations for senior and executive stakeholders, business owners, peers, and external quality improvement organizations at the regional and organization level by: providing consultation on the interpretation, interaction, and implementation of current policies, regulations, and legislation and advices on the current climate and potential changes which may have long term effects on business capability; leading committees, projects to influence decisions on the enforcement, development of policies, or procedures of regulations and auditing processes; maintaining collaborative, results-oriented partnerships with practitioners, staff, and/or management across clinical and administrative roles to ensure compliance with regulations and improve patient safety, reporting accuracy, and health outcomes current and future compliance and advices on current and future KP capability to be continuously adaptive and compliant; designing educational programs to raise awareness for current and changes in regulation requirement, internal concerns, and system/database usage; and identifying systematic barriers to process improvement issues, weighing practical and technical considerations in addressing issues, and recommending corrective actions.


• Provides consultation on the quality of care and review process and complaints by: serving as a subject matter expert for grievance meetings, cases, reviews, referrals, and other mechanisms; responding to and directing the preparations of all documentation, records, and information requested for specific patient case reviews; ensuring consistent follow through on quality of care concerns and analyzing and tracking trends in the process flow of investigations and claims for red flags, appeal reasons, and overturns, and reporting results to senior leaders; and monitoring quality improvement metrics, cases, quality care incidents, and near misses according to established protocols to ensure equal/consistent application of KP policies.


• Leads the development of infection prevention and control programs to improve employee and patient safety by: managing epidemiological research, investigations, and simulations of significant clusters of infection or serious communicable disease concerns as a part of prevention, surveillance, and outbreak management; coordinating, developing, and maintaining significant outbreak containment protocols and efforts; and consulting with Administration on infection control implications of architectural design, renovation, and construction.


• Manages risk management efforts by: leading corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys across departments and regions; enabling others to be compliant with internal and external policies, regulations, and legislation related to quality improvement by interpreting regulations into actionable actions; developing the processes for 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 evaluate newly internalized processes and programs; and developing the process for escalating high-risk issues and trends to appropriate entity for resolutions.


• Serves as the technical expert in patient safety programs and initiatives by: developing and monitoring reporting processes for safety hazards, accidents, incidents, threats, and significant events; and collaborating with key stakeholders, senior management, and external personnel to develop patient strategies based on patient outcomes and leading improvement activities for safer patient practices and services and seamless transition of care.


• Provides consultation in the development of new clinical quality improvement programs by: developing relationships with departments, key stakeholders, and senior management to identify and develop new programs with guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, analyzing program performance, and peer/department review groups; serving as a subject matter expert for a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and researching and investigating innovative opportunities to develop KPs capacity as a learning organization, increasing capacity in areas such as video ethnography, patient-reported outcomes, and harvesting of best practices.


• Develops the systems, procedures, and forms to improve data management programs and utilizes data to monitor and improve performance of all worker and patient safety programs by: ensuring the quality improvement monitoring agenda for assigned departments and regions includes all aspects of data management and analysis of trends and patterns of practice; evaluating the interpretation of statistical analysis for management of quality improvement evaluations; analyzing and interpreting data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and presenting and interpreting reports (e.g., infection control research, utilization reviews, population health needs analysis, patient satisfaction) into specified formats for senior and executive internal and external stakeholders, and publishing results accordingly.


• Serves as a technical resource for regulatory audits and survey efforts by: consulting with applicable government, regulatory, and key stakeholders for onsite visits and evaluations; developing the procedures for preparing requested audit documentation, information, reports, and tools throughout the auditing process; developing the procedures for preparing audit documentation, information, and reports for ad hoc and complex auditing; and designing improvement for continuous survey readiness and monitoring activities to maintain compliance with regulatory standards and advises on KP capability to meet current and future needs.


• Conducts advanced analysis and evaluations of the cost effectiveness, practicality, and appropriateness of medical care given to patients by: participating in complex case reviews with senior leaders and practitioners; partnering with key stakeholders to develop the standard operating procedures for treatment for specific medical codes to ensure equal and timely access to care; analyzing current patient treatment plans to ensure patient needs are met in a timely manner and escalates concerns to key stakeholders; conducting in-depth investigations into population health needs, such as community health concerns, access to transportation, knowledge of rights, reducing no shows, and others, and coordinating with senior internal and external stakeholders to advise on KP capacity to meet these current and future needs; and analyzing previous complex patient cases to identify areas of improvement for length of stay, type of treatment, and time of treatment, and escalating concerns and recommendations to senior leaders.