Claims Quality Audit Manager jobs in Galveston, TX

JOB SUMMARY:

Provide quality and patient safety consulting, analysis and improvement facilitation for staff and leaders throughout the Hospital. Develop, implement, and improve programs to establish and maintain Quality and Patient Safety standards of care provided to patients.  Research, collect and analyze internal and external data for decision making. Serve as a subject matter expert regarding quality and patient safety initiatives and significant event management. Ensure that goals are in alignment with the Health System’s Patient Safety and Performance Improvement plan, strategic priorities and regulatory and accreditation requirements.

Minimum Qualifications:

•  Bachelor’s Degree in a health-related field (Nursing or Ancillary Service) required.
• Minimum of three years of related clinical experience, plus one year of patient safety/risk management experience required.
•  Working knowledge of Joint Commission standards. 
• Excellent oral and written communication skills.
• Strong organizational and data management skills, including Outlook, Excel, PowerPoint, and graphics to design and implement monitoring and evaluation tools.
• Excellent data analytics skills.

Preferred Qualifications:

• Master’s Degree in Nursing, Administration or Business.
• Specialty certification in quality or process improvement.

ESSENTIAL JOB FUNCTIONS

• In collaboration with clinical staff and leadership, participates in the monitoring, reporting, and improvement activities related to clinical guidelines, healthcare quality/patient safety initiatives, accreditation and regulatory requirements. 
• Utilizes systematic, data-driven method(s) to develop, monitor, evaluate, and improve initiatives, programs, and services to improve clinical and operational performance.
• Researches and identifies evidence-based process improvements and helps to set standards and define best practices for assigned departments and projects.
• Actively participates in committees related to risk management, patient safety, and quality improvement, as assigned and warranted.
• Uses data to assist departments in making process changes through facilitation of proactive and reactive process improvement and patient safety activities in regard to planning, implementation, and evaluation of effectiveness of process changes.
• Facilitates continuous process improvement teams using the Plan Do Study Act (PDSA) or Focus Analyze Develop and Execute (FADE) methodology.
• Facilitates proactive and reactive patient safety activities including Root Cause Analyses (RCA), Critical Incident Reviews (CIR), and Failure Mode Effects Analyses (FMEA).
• Monitors, collects, evaluates and maintains data concerning risk and patient safety issues including occurrence reporting through UTMB’s designated reporting system.
• Frequent and ongoing rounding of assigned areas to evaluate the effectiveness of the quality and patient safety program and identify areas of opportunity for performance improvement.
• Provides both formal and informal education on patient safety program, initiatives, and use of incident reporting system.
• Assists with maintaining the transparency and dissemination of Health System metrics and benchmarks. 

Salary Range:

Actual salary commensurate with experience.