Kaiser Permanente Qual Risk Patient Safety Regulatory Consultant in Riverside, California

THIS POSITION IS RESTRICTED TO EXCLUSIVE USE WITHIN THE QUALITY, RISK, PATIENT SAFETY AND REGULATORY DEPT. Key advisor to Clinical and Administrative senior leadership the areas of quality, risk management, regulatory and/or patient safety. Ensures oversight and consistency of operational practices, system processes, standards and accreditations according to the Southern California Region's strategic and operational business plans related to quality, risk management, and patient safety. Identifies and institutes enhanced quality practices based on benchmarking with other industries and internal practice transfer as well as state, federal and local regulations. Facilitates the rapid transfer of best practices across geographical boundaries. Recommends adjustment to operations to ensure continued high levels of performance and compliance with regulatory and accreditation requirements (e.g. NCQA, DMHC, Title 22, Medicare and Medi-Cal, Joint Commission etc.). Provides/gathers clinical expertise for areas of compliance which involve medical necessity and/or quality concerns. Utilizes clinical expertise to conduct investigations and seek input from other clinical professionals as required. Acts as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals. Responsible for reviewing and analyzing audit related reports and providing leadership and consultation on non-compliance and performance improvement in the areas of quality, risk management, regulatory and/or patient safety.

Essential Functions:

  • Leads and/or represents Quality, Risk Management, Regulatory and Patient Safety at routine and ad hoc meetings on specific compliance and regulatory areas.

  • Leads, makes significant contributions, and/or provides technical leadership to high visibility projects to identify and resolve issues of strategic and operational importance to the senior leadership in the Southern California region.

  • Advises clinical and administrative leadership to properly engage team to investigate and facilitate resolution of complex and high profile issues in the areas of Quality, Risk Management, and Patient Safety.

  • Provides/gathers clinical expertise for areas of compliance which involve medical necessity and/or quality concerns.

  • Provides leadership, direct support and consultation on corrective actions developed by departments for areas of non-compliance to ensure the compliance issue(s) is adequately addressed.

  • Works with KFHP/KFH, Medical Group departments and Senior Leadership at divisional, regional, and local levels as consultant on Joint Commission (TJC), Department of Managed Health Care (DMHC), Center of Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and Department of Health Services (DHS) compliance and develops, implements, tracks, and reports on work plans for correction.

  • Participates in the development and implementation of internal audits for TJC, DMHC, CMS, NCQA, DHS, and State Programs compliance.

  • Coordinates the audit process, including reviewing, analyzing, and reporting findings internally to the Director, Senior Leadership, and to KFHP quality committees. Interfaces regularly with senior management to produce timely and valuable results.

  • Produces or oversees development of written materials for various peer groups and high-level audiences.

  • Plans and facilitates meetings.

  • Makes formal presentations to various high-level audiences.

  • May require some travel to the Service Areas and/or Regional offices across the Division.

  • Personal transportation required for local Service Area travel.

Basic Qualifications:

Experience

  • Minimum five (5) years of clinical experience in subject matter area of expertise.

  • Minimum three (3) years of work experience in such areas as quality, risk management, and/or patient safety.

Education

  • BSN or Bachelor's degree in health related field, and/or

  • Graduate of accredited school of nursing required.

  • High School Diploma or General Education Development (GED) required.

License, Certification, Registration

  • Current California RN license required.

Additional Requirements:

  • Strong computer skills (Word, Excel, PowerPoint, etc.). Ability to understand data sources of quality and regulatory information.

  • Excellent interpersonal, verbal and written communication skills. Ability to work with peers in self-managed teams to meet deadlines.

  • Demonstrated conflict resolution and mediation skills with ability to secure action from persons outside their supervision.

  • Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate and ask for help when needed.

  • Ability to multi-task and manage time in order to perform well on long-term projects while being flexible enough to assimilate short term projects on an on-going basis.

  • Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

  • Master's in nursing or public health preferred.

  • CPHH (Certification as Professional in Healthcare Quality) qualification preferred.

Notes:

  • This position will support the Stroke and Sepsis Programs at both Riverside and Moreno Valley Medical Centers.

  • In addition, there will be other duties such as supporting the ED and Neurology Quality Committees.

Notes:

  • This position will support the Sepsis Programs at both Riverside and Moreno Valley Medical Centers.

  • There may be other duties such as support of Quality Management Medical Staff Committees.

COMPANY: KAISER

TITLE: Qual Risk Patient Safety Regulatory Consultant

LOCATION: Riverside, California

REQNUMBER: 736670

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.