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Plans, develops, and implements policies and establishes objectives of all the organization's quality control functions in accordance with organization's objectives. Confers with organization officials to plan business objectives, to develop organizational policies, and to coordinate functions. Directs activities related to quality control including strategies, staffing, scheduling, coordinating, quality assurance standards, and planning. Ensures all areas of organization meet or exceed quality assurance standards. Typically reports to the Chief Executive Officer or Chief Operating Officer.: Recommends new policies or procedures as necessary. Interprets company policy to employees and enforces company policy and practices. Directs assembly of cost control and statistical data and the development of material selection standards. Approves process specification and design standards. Oversees preparation and control of departmental annual budget. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. May plan and establish engineering schedules and follow up performance against estimates.

Head of Quality Improvement- MD

Provides executive leadership over the hospital’s quality improvement process and programs.: Leads the organization's medical quality improvement programs and processes. Provides training and guidance to staff to ensure understanding and that quality, accreditation, and performance improvement are actively pursued. Defines methodologies and directs the collection and analysis of data. Implements processes and methodologies for the identification and sharing of best practices. Promotes support for best practices and evidence-based medicine. Coordinates and oversees quality improvement efforts in operating units. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to quality management. Facilitates and coordinates the redesign of processes and systems for improvement with a central focus on patient centered care and services, customer satisfaction, safety, resource efficiency, quality, and employee satisfaction. Develops new strategies to improve overall performance. Hires, develops and motivates a qualified quality management/improvement staff. This position requires a Medical Doctor.

Total Quality Management TQI Executive

Provides executive leadership over the hospital’s quality improvement process and programs.: This is not a quality assurance position. Directs the development and implementation of programs and processes related to quality management and performance improvement. Directs and controls quality systems for clinical laboratories. Develops policies and procedures, monitors performance, and develops/reviews metrics for areas of responsibility. Identifies, analyzes, designs, measures, and continuously improves business processes that cut across functional boundaries. Assesses and prioritizes risk, conducts mock inspections, and reports results to senior management. May establish quality improvement project teams. Provides training and guidance to staff to ensure understanding and that quality, accreditation, and performance improvement are actively pursued. Implements processes and methodologies for the identification and sharing of best practices. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to quality management. Facilitates and coordinates the redesign of processes and systems for improvement with a central focus on patient centered care and services, customer satisfaction, safety, resource efficiency, quality, and employee satisfaction. Develops new strategies to improve overall performance. Hires, develops and motivates a qualified quality management staff. An advanced degree in health care administration is commonly required for this position. The position requires strong clinical and quality management knowledge.

Quality Improvement Director

Plans, implements, and directs the quality improvement activities of all departments involved in direct patient care and/or services, including medical staff departments, to enhance the quality of service. Reports directly to the CEO or VP of Quality and Patient Services.: Initiates clinical and service performance improvement projects. Establishes strategic plans, policies, and procedures at all levels with all critical operations departments to ensure quality programs will meet or exceed regulatory requirements. Manages the risk management program to control and minimize risks and losses. Ensures that facility meets all accreditation and regulatory requirements and that best patient care practices are implemented and followed. Monitors service indicators, grievance and appeals data, accessibility and availability of provider network, member and provider satisfaction, and over- and under-utilization of services. Conducts focused chart review audits of medical records and assists with the data collection process.

Quality Management Director

Directs and manages quality improvement, preventive health, and related departments of the health plan to identify levels and changes in the quality of medical care. Establishes protocols and serves as a resource regarding accreditation standards and continuous quality improvement principles. Designs, develops, and implements quality improvement initiatives necessary for attaining NCQA accreditation. Typically required to be a graduate of an accredited School of Nursing or a Registered Health Information Administrator (RHIA) with a minimum of four years of experience in direct patient care or in administration of health programs.: Develops and implements educational programs for practitioners and enrollees relative to quality improvement, preventive health, early and periodic screening, diagnosis and treatment, and credentialing. Assists in the development of clinical practice guidelines for use by providers. Oversees hiring, developing, and managing a qualified staff concerned with the evaluation of the quality of member care. Implements the organization's policies on quality standards. May work in conjunction with the Medical Director to assess opportunities for improvement and implement changes that will have a positive impact on medical outcomes and compliance with the plan's policies and contractual objections. Prepares and manages the departmental budget.

Quality Improvement Supervisor

Assists management in the implementation of continuous improvement objectives in the areas of quality, delivery, and cost. Leads teams to execute projects using a variety of continuous improvement tools and methodologies. Leads, coaches, and supports others, including managers and supervisors, in their continuous improvement activities.: Assures compliance with established quality standards, National Committee for Quality Assurance standards, and URAC standards when appropriate. Assures the maintenance of accurate documentation of all quality improvement activities, such as surveys, audits, peer reviews, etc. Prepares the agenda and manages the activities of the health plan's Quality Improvement Committees, in conjunction with Medical Affairs. Remains current with new developments in the field of quality improvement. Develops new Quality Improvement activities in the health plan. Oversees the annual Medical Record Documentation/Preventive Services clinical study. Assures that all quality improvement activities are conducted according to CQI and URAC standards and that appropriate data and documentation are kept. Ensures that quality improvement information, including the monitoring and evaluation of indicators, is collected and reported to the Quality Improvement Committee from the various health plan departments, including credentialing, provider relations, health services, customer services. Maintains data collection for HEDIS measures and identifies opportunities for improvement based on the HEDIS results.

Utilization Review/Quality Assurance Director

Serves as an information coordinator for the hospital-wide quality assurance program. Directs development of monitors, including generic screens, to assess the quality of care provided to patients.: Supports the overall quality assurance reporting system to assure that information is being channeled to appropriate oversight committees. Provides consultation to health care providers as needed to facilitate problem-focused studies of patient care, which may include advice and support for clinical/legal implications of quality issues. May assume Risk Management responsibilities. May supervise several employees.

Quality Improvement Manager

Manages all quality improvement activities of the health plan and assists the director in developing and implementing plans to ensure accreditation. Develops and implements the organization’s quality improvement plan in accordance with the strategic goals of the organization, regulatory standards and accreditation standards. This position typically requires a graduate of an accredited School of Nursing or a Registered Health Information Administrator (RHIA) with experience in direct patient care or in health information.: Manages all quality improvement activities of the health plan and assists the director in developing and implementing plans to ensure accreditation. Develops and implements the organization’s quality improvement plan in accordance with the strategic goals of the organization, regulatory standards and accreditation standards. Provides expertise and technical assistance, consultation and training to staff and service providers regarding laws, statues, rules, regulations and standards. Develops and implements systems, policies, and procedures for the identification, collection and analysis of performance measurement data. Educates and trains executive leadership, staff and business associates on the quality improvement plan. Hires and develops a qualified quality improvement staff. Develops and monitors a departmental budget. Leads, facilitates and advises internal quality improvement teams. Collects and summarizes performance data, identifies opportunities for improvement, and presents findings. Manages monitoring and evaluation of facility and clinical quality improvement activities. Analyzes customer survey data to identify opportunities for improvement and presents findings to appropriate departments. This position typically requires a graduate of an accredited School of Nursing or a Registered Health Information Administrator (RHIA) with experience in direct patient care or in health information.

Claims Quality Audit Director

Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically requires a college degree in a related field and an in-depth understanding of claims auditing.: Provides oversight of departmental training and auditing activities. Monitors departmental operations to ensure compliance with regulatory agencies and contractual obligations. Develops strategic initiatives and transforms initiatives into action plans. Hires, trains, and motivates a qualified management staff. Oversees the development of training programs that are targeted toward error reduction and decision quality in claims processing. Analyzes audit and training reports to determine department effectiveness.

Quality Control Manager

Manages, plans, coordinates, and directs quality control program designed to ensure continuous production/service consistent with established standards. Manages the development and analysis of statistical data and specifications to determine present standards and establish proposed quality and reliability expectancy. This is typically the second level of supervision and a Quality Control Supervisor/Administrator may report to this position; however, in smaller organizations, this position may be the first level of supervision.: Formulates and maintains quality control objectives, and coordinates objectives with production procedures in cooperation with other managers to maximize quality and reliability and to minimize costs. Manages, through intermediate personnel, workers engaged in activities to ensure continuous control over materials, facilities, services, and products. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures, progress reports, etc., in order to inform management of current status or work activities. Plans, promotes, and organizes training activities related to quality and reliability. Analyzes and resolves work problems, or assists employees in solving work problems. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. Interprets company policy to employees and enforces company policy and practices. May investigate customer complaints regarding quality and make appropriate adjustments.

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