Director Quality and Risk Management - Healthcare

Job Summary The Director, Quality Risk Management is responsible for overseeing the facility's quality improvement and risk management programs. This role works to promote patient safety, regulatory compliance, and effective risk mitigation strategies across the organization. The Director collaborates with clinical and administrative leaders to implement best practices, assess risks, and ensure continuous improvement in care quality and patient safety.

Essential Functions

Leads quality and risk management initiatives, ensuring alignment with regulatory standards and industry best practices.

Develops and implements risk assessment and mitigation strategies to identify, prevent, and address potential patient safety concerns.

Conducts root cause analyses, Failure Modes and Effects Analysis (FMEA), and other methodologies to investigate adverse events and implement corrective actions.

Collaborates with department heads to develop and track quality improvement plans and performance metrics, driving improvements in clinical and operational areas.

Oversees compliance with The Joint Commission, CMS, and other accrediting and regulatory agencies, preparing the facility for surveys and audits.

Provides education and training to staff on quality improvement, risk management, and patient safety standards.

Prepares and presents reports on quality and risk metrics to leadership, committees, and the Governing Board, supporting data-driven decision-making.

Performs other duties as assigned.

Maintains regular and reliable attendance.

Complies with all policies and standards.

Leadership Responsibilities

Supervision and Staff Management

Provides leadership, mentorship and professional development opportunities for departmental staff.

Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues.

Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.

Strategic Planning and Financial Oversight

Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long‑term planning.

Monitors expenditures, ensuring cost‑effective delivery of services.

Evaluates and implements new technologies to enhance operational efficiency.

Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.

Quality Assurance and Regulatory Compliance

Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.

Participates in audits, inspections and accreditation processes as applicable.

Follows established quality control practices to ensure accuracy, consistency and safety.

Collaboration and Communication

Works closely with leadership teams to coordinate and improve service delivery.

Stays up‑to‑date with industry advancements, new technologies, and regulatory changes.

Staff Responsibilities

May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

Bachelor's Degree in relevant field required or

Seven (7) plus years of direct experience in lieu of a Bachelor's degree required

Master's Degree preferred

3-5 years of experience in closely related field with Bachelor's degree required

3-5 years of previous leadership experience preferred

Knowledge, Skills and Abilities

Strong leadership, organizational, and communication skills.

Ability to collaborate with interdisciplinary teams and manage cross‑functional relationships.

Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.

Communicate effectively with leadership, team members, and stakeholders.

Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.

Problem‑solving and critical thinking skills.

In depth knowledge of industry best practices and regulatory compliance (if applicable).

Strong organizational and time management skills.

Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

RN – Registered Nurse – State Licensure and/or Compact State Licensure required

CPHQ – Certified Professional in Healthcare Quality preferred

Certified Professional in Patient Safety (CPPS) preferred

CPHRM – Certified Professional in Healthcare Risk Management preferred

What we offer

Competitive Pay – Medical, Dental, Vision, & Life Insurance

Generous Paid Time Off (PTO) & Extended Illness Bank (EIB)

Matching 401(k)

Opportunities for Career Advancement

Rewards and Recognition Programs

Additional Discounts and Perks*

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