The regulatory function is vital in making safe and effective healthcare products available worldwide. Individuals who ensure regulatory compliance and prepare submissions, as well as those whose main job function is clinical affairs or quality assurance are all considered regulatory professionals.
One of our most valuable contributions to the profession is the Regulatory Code of Ethics. The Code of Ethics provides regulatory professionals with core values that hold them to the highest standards of professional conduct.
Like all professions, regulatory is based on a shared set of competencies. The Regulatory Competency Framework describes the essential elements of what is required of regulatory professionals at four major career and professional levels.
Join the brightest minds in regulatory at the annual Regulatory Convergence. See the global regulatory community in action. Intensive workshops. Topical sessions. Meet ups with regulators. This is where it all comes together.
This job description describes in general the nature and levels of work, knowledge, skills, abilities and other essential functions, as defined under the Americans with Disabilities Act, expected of an incumbent. It is not designed to contain a comprehensive listing of activities, duties or responsibilities required of an incumbent and an incumbent may be asked to perform other duties as required.
Chief Executive Officer
Manager, Patient Care Systems
Manager, Infection Prevention & Control
Clinical Documentation Improvement Specialist
Administer and improve the quality assessment and performance improvement infrastructure and plan for CHS. Manage, track, and evaluate performance measures, identify data trends and make recommendations for new health center clinical and operational quality improvement initiatives when appropriate. With the Chief Legal and Human Resources Officer, act as the co-risk manager, ensuring that actual or potential clinical, operational and business risks are identified and mitigated.
· Oversee the advancement and continued improvement of the Quality Assessment and Performance Improvement program, including the appropriate monitoring and evaluation of clinical and administrative systems to ensure effective, high quality, efficient operations
· Provide strategic vision and oversight for creating a culture of safety; identify and deploy tools necessary to support safety, including but not limited to enhanced systems of internal and external reporting, root cause analysis and failure mode and effects analysis
· With other members of the executive team, identify, prioritize, and lead enterprise-wide strategic improvement opportunities
· Provide consultation, motivation and technical assistance to CHS leaders and other staff to identify the most effective ways to organize, manage, finance, and deliver high-quality care
· Represent the executive team at Board of Director and relevant subcommittee meetings, including the Quality Committee
· With the Chief Medical Officer, leads the organization in understanding, communicating, achieving and sustaining quality standards necessary to maintain accreditation through the Joint Commission, NCQA, and/or other accrediting bodies
· Collaborate with Information Technology staff to continuously improve system capabilities for obtaining and utilizing the data necessary to assess and improve functions at the health center.
· With the Manager of Infection Control & Prevention, oversee the effective implementation of the organization’s infection control and prevention program and compliance with regulations, recommendations, and guidelines of relevant regulatory agencies, including The Joint Commission, HRSA, DPH, and OSHA.
· In partnership with the Chief Medical Officer and the executive team, evaluate utilization patterns and costs associated with practice patterns, interventions, implementation efforts, policy changes, and related health services topics
· Provide oversight for the delivery of nursing care, including but not limited to the development and implementation of nurse-driven models of care, including systems for patient navigation and coordination of care, deployment of protocols for nurse sensitive visits, systems and resources for patient education.
· Oversee patient experience and engagement using surveys and other tools to support data collection, and analysis of data; develop strategies to enhance patient engagement and support a patient-centered approach to care delivery
· In partnership with Human Resources, develop, facilitate, implement training programs to ensure clinical staff maintain the appropriate level of clinical competence to perform services
· Oversee and support the development, implementation, and implementation of the organization’s emergency preparedness plan.
Risk Management (with the Chief Legal & Human Resources Officer)
· Oversee day-to-day monitoring of patient safety and risk management activities
· Establish and maintains systems for reporting and investigating actual or potential incidents that pose clinical, operational or business risk
· Serve as a primary contact between the organization and external parties on all matters relative to risk identification, prevention, and control
· Oversee the reporting of events to external organizations per regulations and contracts
· Communicate analysis and feedback of reported risk management and patient safety information to the organization for action
· Advise the executive team and Board of Directors on the design and implementation of new programs by identifying new funding opportunities, drafting prospective programmatic budgets, and determining the costs, benefits, and financial effectiveness of prospective services
Develop and sustain positive and productive relationships with community, government, and business leaders to advance organizational objectives
Maintain a positive image of the health center in the community by representing the organization on boards, commissions, councils, workgroups, and committees as well as at government and community events
Maintain a deep knowledge of the health care environment generally and the FQHC environment in particular
Perform all duties in accordance with CHS Core Values, Compliance Program, and other policies and procedures
Participate in quality and process improvement efforts in the department and the organization as requested or as directed
Complete training and professional development requirements in a timely manner
Perform other duties as assigned or directed
KNOWLEDGE, SKILLS, and ABILITIES
Minimum education and experience required:
· BSN, RN with 10+ years of clinical experience in acute care or an equivalent setting
· CPR certification at the healthcare provider level or eligible to obtain certification within 90 days of hire
· Extensive knowledge of improvement methodology (such as PDCA)
· Significant experience using clinical data analytic tools and, in the analysis, and interpretation of data
· Experience successfully managing enterprise-wide projects or initiatives
· Five (5) years of experience in quality assessment and performance improvement management with a demonstrated record of coordinating multiple related projects.
· ECRI certification as a Clinical Risk Manager or eligible to obtain certification within 90 days of hire
· MSN, MPH, MD or other advanced degree in a healthcare related field
· Training in Lean or Six Sigma
· Understanding of care delivery models in the outpatient or ambulatory setting
· Extensive experience designing, facilitating or implementing clinical education or training programs
· Significant experience implementing, customizing, or improving electronic health record systems
Other key factors:
· Ability to successfully develop, mentor, coach and manage the performance of others
· Highly-developed analytical ability
· Expertise in leading and facilitating multi-disciplinary teams, to move the organization to new levels of excellence, while building a culture of continuous improvement
· Ability to think strategically
· Frequent long hours and weekend work
· Ability to maintain a high level of personal and business integrity and confidentiality and to exercise discretion in handling sensitive situations
· Ability to maintain focus, objectivity and professionalism in stressful situations
· Ability to work in a fast-paced work environment with competing and/or changing priorities
· Must be able to travel to various work-site locations on demand
· Clear and effective oral and written communication
· Ability to make data-driven decisions
· Requires working in a collaborative, cross departmental and enterprise-level work groups
Other information impacting scope and complexity of position
Executive level position with frequent contact with community and business leaders. Requires exceptional people skills that support the establishment and maintenance of effective working relationships with executive team colleagues, members of the management team, clinical staff, other personnel, and the public
TYPICAL PHYSICAL DEMANDS: Largely a sedentary role. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. Requires the ability to hear and to communicate orally with others.
TYPICAL WORKING CONDITIONS: This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment.
Community Health Services is An Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status, age or any other legally protected class.
Community Health Services, Inc. (CHS) is a private nonprofit (501 (c)3) federally qualified health center (FQHC) with two locations in the Greater Hartford area. CHS is the second oldest health center in the state of Connecticut. CHS started as a very organic institution in 1970, as a result of Dr. Evans Daniels Jr's private medical practice that saw an overwhelming need in the Hartford community. Under Dr. Daniels guidance for 30 years, CHS grew and expanded to our current three story state of the art medical facility at 500 Albany Avenue, Hartford, CT. Just like Dr. Daniels vision of addressing community needs, we have recently opened a satellite office in 2013 to include additional primary care services at 503 Windsor Avenue, Unit 511 in Windsor, CT. With hopes of continually growing, we are looking forward to expanding services at both our main site and satellite location!
Since 2003, CHS has continuously been accredited by the Joint Commission on Accreditation of Health Care Organizations. This accreditation is representative of our commitment to excellence in our clinical practices and providing every patient the quality of care they deserve. We serve a patient-base of alm...ost 17,000 individuals and accommodate over 77,000 patient visits each year. As a FQHC, we are committed to caring for each individual who enters our doors, regardless of their income and whether or not they have insurance. At CHS, you can bring your entire family, and receive the same close, personal care and medical expertise you would expect from a private practice or hospital. While 80% of our patients live in Hartford, we have become the medical home of choice for residents who choose to travel throughout the state to come use our services!