Performance Improvement Quality Program Coordinator, TMC

Houston, Texas
Feb 13, 2018
Mar 13, 2018
Contract Type
Full Time
Quality Program CoordinatorPhytex Mischer Neuro Assoc.

Job Description
The Quality Program Coordinator II is responsible for coordinating and facilitating Memorial Hermann Mischer Neuroscience Associates’ (MNA) quality programs by interfacing with clinicians and administration to ensure implementation of quality initiatives, safety programs, and compliance with regulatory agencies as needed. Regularly meets with various departments for clinical review ensuring regulatory standards, System goals, physician and patient satisfaction, and program compliance. Assisting in physician and clinical staff in the expeditious use of EMR and enhance the patient care experience. Being able to utilize principles of Quality and Performance Improvement (QPI), and conduct chart review and case presentations for clinical quality review. The position will be entrusted with patient level quality data, and assures appropriate data collection, abstraction, analysis, and reporting of noted measures, to support quality and performance improvement efforts.


Graduate of a school of vocational nursing.

Current State of Texas license/permit to practice licensed vocational nursing.

Minimum 2 years clinical care experience as an LVN; has acquired skills related to specific specialties.

EMR experience preferred.

Two to three years’ experience working in multi-physician practices or multispecialty practices

Two to three years clinical experience to ensure knowledge base sufficient to train and support clinical requirements of quality programs.

Demonstrates effective working relationship with physicians.

Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

Demonstrates proficiency in word processing, development of spreadsheets, and QPI analysis. Demonstrates commitment to the Partners-in-Caring process by integrating both Behaviors and Operating Principles in all internal and external customer interactions. Performs duties withaccountability, competency, innovation, collaboration, compassion and respect to create the best possible outcomes with exceptional customer experiences.

Principle Accountabilities:

Work in conjunction with the Director of Hospital Operations and Director of Strategic Analytics to develop, implement and promote MNA’s quality programs across all system facilities and clinics.

Provide ongoing staff education on clinical workflows and compliance improvement.

Provide quality compliance reports and support to MNA Quality Team and other areas as necessary.

Maintain current knowledge of CMS, and other regulatory agencies’ standards/regulations. Instruct and direct staff on applicable regulatory standards to ensure compliance.

Organize and coordinate new employee documentation review. Present proposed changes to existing policy and procedures to Director of Hospital Operations and Director of Strategic Analytics.

Coordinate, develop and implement special projects as directed by MNA Medical Director and/or Director of Hospital Operations and Director of Strategic Analytics.

Conduct targeted chart review to identify adverse events, compliance fallouts, and variance from standard of care with a focus on root cause analysis. Prepare case reports for individual neurosurgical services at the Texas Medical Center and other System hospitals. Prepare and present quality data at departmental and system meetings.

Understanding of QPI methods and models in healthcare, such as PDSA, TQM, Six Sigma, RCA, and RPI.

Adheres to all Memorial Hermann policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.

Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

Other duties as assigned.

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