ESSENTIAL FUNCTIONS:

· Assist the Risk and Quality Directors in all areas of execution regarding the risk management program throughout the facility.

· Promote a culture of safety by encouraging incident reporting.

· Lead investigations following incidents, complaints, grievances.

· Collaborate with employees to streamline the incident reporting process making it more effective and efficient.

· Identify risks that could potentially result in harm to patients, staff, or visitors.

· Coordinate incident data collection and analysis from all departments within the facility.

· Coordinate the development of corrective action plans for the resolution of areas of regulatory vulnerability or those which could compromise patient safety in collaboration with other facility leaders.

· Assist leadership with building sustainable and repeatable processes for Quality Council, policies and procedure review, Safety Committee, safety and incident data analytics, and internal reports.

· Responsible for compiling and distributing material prior to Risk, Quality, and Performance Improvement meetings, Governing Board, Quality Council, Medical Executive Committee, and other meetings as assigned, as well as recording the minutes.

· Serve as a visible, engaged, and dynamic team member.

· Complete safety rounds, participate in leadership rounding, and submit results/corrective actions to facility leaders and Acadia corporate office, as directed.

· Responsible for department records management.

· Assist with coordinating and training activities for facility staff to ensure compliance with regulatory agencies, as needed.

· Assist with the coordination of Risk Management and QAPI programs, as requested.

· Track Risk and Quality/QAPI projects as assigned throughout the facility,OTHER FUNCTIONS: 

· Perform other functions and tasks as assigned. 

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

· High school diploma or equivalent required. 

· Associate or Bachelor's degree within a clinical healthcare field such as nursing or counseling preferred. 

· Experience with CARF, DEA, Joint Commission, or CMS surveys, as required by service line(s) supported 

LICENSES/DESIGNATIONS/CERTIFICATIONS: 

· CPR and de-escalation/restraint certification required (training available upon hire and offered by facility). 

· First aid may be required based on state or facility.