Clinical Quality Compliance Consultant, Winston Salem

JOB SUMMARY: 

Under supervision, works to strengthen Wake Forest Baptist Health's system-wide quality outcomes reporting and improvement activities. Works with leadership to comply with an increasing number of external reporting mandates and improvement initiatives including data collection, data entry, and analysis of quality data. In addition, responsible for data display and interpretation, and the reporting of this data to a wide range of clinical and administrative leaders. Extensive, daily interaction with Directors and staff in the Performance Excellence division is a key component of this role. Participates in a variety of programs and improvement activities across multiple academic and operational departments. 

EDUCATION/EXPERIENCE: 

• Graduation from an accredited School of Nursing with a Bachelor's degree in Healthcare of a Business related field; or, ten years nursing experience in an academic medical center and three years of clinical quality review related work experience required
• Master's degree preferred. 
• Three years' experience in quality measurement and/or improvement, patient safety, or health science research preferred. 
• Experience working in a complex health care organization (e.g., academic medical center) preferred. 

LICENSURE, CERTIFICATION, and/or REGISTRATION: 

• Current license to practice as a Registered Nurse (RN) in the State of North Carolina. 
• Certified Professional in Healthcare Quality preferred. 

ESSENTIAL FUNCTIONS: 

1. Facilitates compliance with evolving quality measures including, TJC Oryx Reporting of Core Measures, Leapfrog, CMSs National Hospital Quality Measures, and National Quality Forum quality measurement and reporting requirements, and other benchmarking reporting requirements. 

2. Develops both measurement and improvement strategies for assigned performance measures and programs. 

3. Oversees clinical review in area of responsibility to ensure complete and accurate data collection and data entry for assigned performance measures and programs/projects within established timeframes. 

4. Works with Quality Department leadership to investigate quality concerns or issues arising from external payer reviews, external clinical benchmarking efforts (NSQIP, UHC, Leapfrog, TJC, etc.), or tracking of surveillance of major outcome measures (e.g., mortality, readmission, and reoperation rates). 

5. Provides concise clinical quality review findings, develop recommendations for corrective actions and/or improvement opportunities to leadership as warranted, and track the impact of implemented changes. 

6. Works with assigned team and quality leaders across the medical center to strengthen clinical documentation and coding to ensure that all DRG related and CPT related coding accurately reflects the patient?s complexity and clinical course. Monitors review process for all hospital acquired conditions and publicly reported conditions to ensure accuracy of information provided to regulatory reporting agencies. 

7. Works with Quality Assessment Director and Performance Excellence division leaders to manage specified quality and safety related projects as determined by leadership, including developing project timelines, agendas, reports, and presentations to various audiences as appropriate. 

8. Establishes effective and collaborative working relationships with members of the hospital community, clinical departments, administrative departments, and quality and safety staff across Wake Forest Baptist Health. 

9. Keeps current with data abstraction specifications, emerging trends in hospital quality and reporting initiatives, and integrates key concepts into work. 

10. Performs other duties as assigned. 

Atrium Health Wake Forest Baptist is a pre-eminent academic health system based in Winston-Salem, North Carolina. Atrium Health Wake Forest Baptist is part of Advocate Health, which is headquartered in Charlotte, North Carolina, and is the fifth-largest nonprofit health system in the United States, created from the combination of Atrium Health and Advocate Aurora Health. Atrium Health Wake Forest Baptist’s two main components are an integrated clinical system – anchored by Atrium Health Wake Forest Baptist Medical Center, an 885-bed tertiary-care hospital in Winston-Salem – that includes Brenner Children’s Hospital, five community hospitals, more than 300 primary and specialty care locations and more than 2,700 physicians; and Wake Forest School of Medicine, the academic core of Atrium Health En