Description

Department:

37278 Wake Forest Baptist Medical Center - LC: Administration

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Focus on American College of Surgeons Oncology programs

Pay Range
$34.90 - $52.35

Essential Functions

• Leads continuous accreditation readiness efforts and coaches others in the development of accreditation improvement capabilities. Provides direction to department and facility leadership in the planning of a systematic, organization-wide approach to continuous accreditation readiness.
• Maintains expert competence in accreditation standards and communicates relevant changes to appropriate leaders and staff.
• Maintains a close working relationship with facility leadership to optimize the quality and patient safety culture and to support constant state of readiness for accreditation reviews.
• Facilitates assessments, develops, implements and evaluates corrective action plans based on past surveys and preparatory tracer activities. Compiles and distributes compliance reports including appropriate action plans to oversight councils. Supports and guides the facility in continuous survey readiness efforts.
• Participates in the review, analysis and development of plans.
• Prepares reports and presentations.
• Coordinates department and facility accreditation compliance meetings, analyzes trends of performance metrics, identifies opportunities for improvement, develops action plans, measures success of these action plans, creates the records and follow-up metrics for each meeting and activity. Re-assesses approach to maximize success.
• Assists leadership in defining key performance indicators and developing measurement tools to evaluate quality improvements.
• Utilizes facilitation skills (both team and individual), data analysis and statistical process control to effect improvement in quality and clinical outcome.
• Consults with and trains staff to implement monitoring and measurement tools, and data analysis techniques. Provides education and training on accreditation compliance and accreditation matters.
• Collaborates with staff to facilitate improvement teams to achieve facility and System quality and patient safety goals.
• Assists with system and regional quality initiatives.

Physical Requirements
Works in an office environment. Requires walking, standing, long periods of sitting and computer use. Intact sense of sight and hearing required. Travels to facilities as needed. Must have current state driver's license.

Education, Experience and Certifications

Bachelor's Degree required; Master's Degree preferred. RN or other clinical licensure preferred. Certification in healthcare quality, patient safety or related accreditation entity preferred, required within 1 year of employment.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Oversees the daily continuous accreditation readiness for assigned facility(s). Coordinates department and facility accreditation compliance meetings, analyzes trends of performance metrics, identifies opportunities for improvement, develops action plans, measures success of these action plans, creates the records and follow-up metrics for each meeting and activity.