Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
DIRECTOR OF QUALITY & PATIENT SAFETY
Rutland Vermont
This position has overall accountability for all aspects of quality improvement, regulatory readiness for the entire organization. This responsibility includes setting the strategic direction for programs and functions necessary to support the organization in the pursuit of high-quality care and effective operations.
The Director develops, deploys, and evaluates performance improvement & risk reduction initiatives and processes that help improve patient care delivery and safety, enhance administrative operations, and create a culture of continuous improvement & excellence within the hospital by maximizing the potential of its people, processes, and systems.
The Director works in a collaborative manner with Leadership, the staff of entities and with members of the Medical Staff. This position uses effective strategies in developing, supervising and evaluating work processes, compliance with regulatory and professional standards, resource consumption, planning and outcomes, working in a collaborative manner with all organizational employees.
Minimum Education
Bachelors of Nursing (BSN) required
Master’s Degree in healthcare administration, public health, clinical field or a related area preferred.
Minimum Work Experience
Experience in an acute care setting in quality improvement or risk management.
Experience in formalized quality improvement, business and strategic planning activities, management and financial planning and budgetary cost control, preferred.
Required Licenses/Certifications
Licensed in the State of Vermont
Certified Professional in Healthcare Quality (CPHQ) or Certified Professional in Patient Safety (CPPS) preferred.
Certification in Lean Six Sigma or other process improvement methodology strongly preferred.
Required Skills, Knowledge, and Abilities
Thorough understanding of the health care environment, trends and issues.
Familiar with the Center for Medicare & Medicaid Services (CMS) and The Joint Commission standards and processes for survey & accreditation
Strong leadership skills with ability to mentor others
Excellent analytical skills and attention to detail.
Significant experience with process improvement & change management work and ability to create a culture that supports quality
Strong written and verbal communication skills.
Excellent diplomacy, problem-solving, conflict management, team building, and collaboration skills.
Ability to read and quality & financial reports and understand and apply to areas of responsibility to support the organization in achieving its goals.
Excellent organizational and time management and self-motivation skills.
Strong Microsoft Windows desktop application and navigation skills.
Knowledgeable regarding budget development.
Strong knowledge of Microsoft desktop applications