Minimum Experience:3 years utilization review/quality management exp.
Specialty Type:Not Applicable
Under general supervision, coordinates departmental quality improvement activities to ensure consistency with organization policies, procedures and philosophy, and to maintain and improve the quality of care given to the patient. Develops, implements and documents activities relating to the Quality Assurance Program. Collects, and analyzes data, conducts presentations, provides consultation, and staffs hospital-wide committees.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Plans, organizes, and directs departmental quality improvement activities. Conducts departmental studies of identified problem areas in accordance with the Quality Management Plan.
2. Analyzes and assesses the important aspects of care (such as appropriateness of diagnosis, blood transfusions, indication for surgery, clinical pertinence of medical record documentation, complications, anesthesia care, infections, utilization issues, etc.) for specific patient populations which represent important clinical issues and reflect the strategic clinical direction of the organization. Identifies areas for improvement.
3. Develops strategies and action plans to correct the improvement areas. Responsible for ensuring that the goals are met based off of the action plans.
4. Facilitates multidisciplinary teams to achieve improved quality care.
5. Collects quality and risk management data on an ongoing basis such as unplanned readmissions, deaths, unplanned returns to the operating room, Maryland Hospital Association Quality Indicator Project Indicators, Clinical Quality Indicators for Board Report, occurrence screens, TPN usage, blood transfusion record completeness.
6. Develops effective working relationships with Utilization Review Nurses, Risk Managers, Case Managers, and Clinical Practice Coordinators to assure cooperation and data sharing which results in improved patient care.
7. Provides consultation to ancillary support and clinical departments within the Medical System to establish quality indicators, analyze quality and utilization data, identify trends/patterns and formulate plans for resolving issues/problems.
8. Staffs organization-wide quality improvement committees and participates on process management teams.
Bachelor’s degree in Nursing, or an equivalent combination of education and experience, is required.
Current licensure as a Registered Nurse in the State of Maryland is required.
Three years of professional experience performing utilization review/quality management activities, or equivalent, is required.