Quality Improvement Analyst

Location: 1035 Cambridge Street 

Work Days: 8-5  

Category: Professional and Management  

Department: Quality Management  

Job Type: Full time  

Work Shift: Day 

Hours/Week: 40.00 

Union: No 

Union Name: Non Union

DEPARTMENT DESCRIPTION:

The Division of Quality is responsible for promoting a culture of safety, patient and staff engagement, and performance excellence aligned with national patient safety goals.   

Summary:
Perform and participate in activities to facilitate continuous quality improvement throughout the Departments. Monitor regulatory compliance, consult with and support inpatient units and outpatient teams around quality improvement, reporting needs and database administration. Track and ensure the integrity of the data.

Responsibilities:
• Oversees all reporting systems within the Department and produces reports monthly, quarterly, annually and ad hoc to meet the needs of the department. Monitors and ensures data integrity of reports.
• Facilitate quality improvement initiatives within the Department. Assist in the planning, design, data collection, implementation, reporting and monitoring of QI initiatives.
• Consult with inpatient units and outpatient programs around quality issues. Provide suggestions for improvement. Participate in accreditation and licensing tracers, and environmental rounds.
• Assists with preparation for DMH licensing, Joint Commission accreditation, and other external reviews by funding sources.
• Project manager for HBIPS CMS core measures, CANS, Patient Experience of Care reporting, and other PFP and PFR measures. Completes data abstraction and reviews as necessary.
• Liaison for the RISK reporting and Complaint Feedback systems. Provides technical guidance, analysis and reporting on all risk management data and complaint information.
• Facilitates the review and revision of policies and procedures for the department.
• Manages the Department of Psychiatry’s Epic Clinical Content Committees, ECT Committee and Data Group.
• Trains residents and staff on aspects of completing treatment plans, assessments and other required documentation.
• Assists with the facilitation of external investigations, consultations and internal risk reviews including: root cause analyses and reviews of other sentinel events. Participates in the Complex Case Review Committee.
• Participates in committees to represent the Department of Psychiatry as needed. Conducts ad hoc projects as needed.
  

MINIMUM QUALIFICATIONS:

Education/Training: BA or BS in database administration/analytics, or related field. Equivalent, relevant experience may be substituted for a degree.
Work Experience: One-three years’ quality improvement, and database administration/analytics experience.

 
In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.