Quality Services Professional

I am an International Medical Graduate with 20 years of Quality Management and Regulatory Affairs experience. . I have a diploma in Risk Management from New York University. I have four (4) previous Director-level positions and am looking for a similar role. As a physician and attorney, I have focused my professional activities in Quality and Risk Management, such as:

•Accreditation, JCAHO survey preparations, CMS regulations, EMTALA regulations and Mock Surveys

•Utilization Management as a Physician and an Administrator

•Healthcare Risk Management, Chart Review Legal Consultant, RCA

•Patient Safety, Policies and Procedures, FMEA, Infection Control

•Database creator and Data Management, Transforming data into information, Epidemiology and Statistics

•Physician Credentialing and Physician Relations

•Patient and Guest Relations, HCAHPS

•Disease Management, Population Health Planning, HEDIS, NCQA, Medicare, Medicaid, Managed Care

•Acute care, Long Term Care, Behavioral Care, Ambulatory Care, Surgical Centers, Dialysis

•Assess, Diagnose, Plan, Monitor and Evaluate all aspects of the Quality Management program

•Independent Consultant since January 1999

Career History

Law Offices January 2014-Present

Independent Consultant/ Quality and Risk Management (Private Law Offices)

•Provide chart review to determine gaps and liability. Draft of pleadings, briefs, summaries.

Hospital Center January 2009-December 2013

Executive Director of Quality Management and Regulatory Affairs

•Implement best practice guidelines and monitor compliance.

•Medical records review to determine compliance with the best practice guidelines. Report results to the leadership.

•Cooperate with Nursing to have patients coming back to the clinic to complete certain tests as required by the best practice guidelines.

•Design population health program for diabetic, hypertensive and other cardiovascular diseases patients, prenatal care, immunization and certain infectious diseases as diarrhea.

•Receive complaints and conduct investigation to decide on substance. Place substantiated complaint results in physician files as well as compliments. Prepare reports of Patient Satisfaction, Patients Complaints and share information with leadership and staff.

•Review cases that resulted in an unexpected outcome. Identify the gaps and seat with involved staff to identify the root causes. Create reports and share information with Patient Care staff to prevent further occurrences.

•Review and Revise policies as necessary to improve Patient Safety. Ensure that FMEA are created for the critical care areas. Prepare reports on Patient Safety and share with the leadership.

•Promote Infection Control measures and asepsis to reduce and prevent nosocomial infections in the surgical center. Review labs to determine patients with infections. Identify nosocomial infections and create reports to be shared with the staff during staff and leadership meetings.

•Be a liaison between the medical center and physicians to create an interest in their participation.

•Keep all physician credentialing files up to date.

•Ensure that Utilization Management activities are effective and ensure that denials are reviewed and processed for reimbursement.

•Review the guidelines and implement standards in order to keep the facility survey ready and to prepare the facility for a future accreditation.

•Prepare the facility for all other voluntary accreditations.

•Prepare reports of all monitoring activities.

•Share reports with the staff and the leadership during meetings.

•Educate staff on best practice guidelines and recommend education material for staff conference.

•Prepare Annual Performance Improvement Appraisal.

Chart Review offices May 2007-December 2008

Independent Consultant/ Quality and Risk Management

•Review charts at law offices to determine liabilities.

Bon Secours Health Systems, Inc. (BSHSI), Baltimore, MD January 2005-May 2007

Director of Quality Management

•Review and updated the Strategic Quality Plan (SQP), completed the SQP Annual Appraisal, the Employee JCAHO Orientation Manual, re-engineer many performance improvements projects and Core Measures to achieve substantial compliance.

•Facilitate the development of customer satisfaction and process performance measures.

•Evaluate policies in light of CQI strategy and make recommendations for changes consistent with a quality management philosophy. Complete FMEA and share reports with Managerial staff and leadership.

•Provide support and advice to Administrative and Management Councils regarding CQI activities;

•Administrative oversight of Patient Safety, Patient Rights, Risk Management, Utilization Review, Credentialing, Medical Staff and Infection Control.

•Report and appraise the leadership with Patient Safety, Patient Rights, Risk Management, Utilization Review, Credentialing, Medical Staff, Performance Improvement and Infection Control data in leadership executive meetings.

•Update Periodic Performance Review with the Joint Commission.

•Provide oversight to all other hospital departments by receiving reports through the Hospital-Wide Strategic Quality Plan.

•Confer with other administrative personnel to coordinate departmental activities and major multi-departmental and, /or divisional projects regarding CQI activities.

•Facilitate the annual organizational evaluation of the performance improvement process and revise the QI Plan accordingly.

•Ensure the link between the OI Plan and the SQP process.

•Work collaboratively with Financial Administration and information Services to establish and maintain a productivity monitoring system.

•Develop and maintain an awareness of the latest techniques in CQI by attending seminars and conferences.

•Provide CQI expertise and training to the facilities within the Corporation and other facilities with the Health system as requested and feasible.

•Assist with and often take an active part in data analysis and presentation of CQI results, especially as a consultant to the CQI and SQP Project Teams.

•Provide communication on CQI to the employees and management staff of the Corporation.

•Evaluate and coordinate activities to ensure the Hospital's compliance with JCAHO standards and supports other entities accreditation/licensure as requested.

•Work with professional committees, task forces and teams as requested.

•Direct the orientation of personnel to the Quality Improvement Plan and interpretation of JCAHO performance improvement standards.

•Participate in on going staff development in performance improvement techniques for individuals, departments and ambulatory centers.

•Identify opportunities for organizational improvement and search collaborative action for process improvement through the effective application of the Quality Improvement Plan, the Risk Management Plan, Environmental Safety policies and procedures, and the organizational mission and vision.

•Develop, implement, and evaluate the Quality Management Department's goals and objectives, operations standards, and annual operating and capital budgets; monitor performance and reengineer some processes to facilitate compliance.

•Direct the activities of subordinates through effective selection, performance appraisal and personnel actions consistent with human resources policies and procedures; provide for the professional development of staff at all levels.

•Provide for the cost-effective utilization of the department's human and material resources consistent with the corporation goals of cost containment, quality and productivity; conduct evaluation of results.

•Confer regularly with the Vice President for Care Management, Senior Vice President of Operations to report activities, discuss barriers to progress and solutions, maintain the open flow of communication and participate in the management process

•Claims management and Incident Reporting - oversight of the event and incident reporting systems, analyzes and respond to reports, compile summaries of reports, report potential claims to carriers, review patient/family/physician complaints for liability risk and resolution.

•Program Administration - Develop, coordinate, and administer hospital wide systems for risk identification, investigation and reduction, maintain statistics, ensure that pertinent patient data relative to a claim is accurate, available, and secure. Review and coordinate trend analysis, claims profiles, worker's comp trends, and analysis of risk data. Advises security on loss reduction of property and assets. Develop, review and revise policies and procedures related to Risk Management.

•Legal Interface - Work with hospital legal counsel to coordinate the investigation, processing, and defense of claims. Respond to professional liability and hospital liability questions and maintains knowledge of legislative and regulatory activities related to health care risk management.

•Education - Provide in-service training to enhance awareness of employee's role in reducing liability exposures. Disseminate information on claim patterns and risk control, legislative and regulatory changes.

Harlem Hospital Center, NYC Health & Hospital Corp. Manhattan, NY January 1999-January 2005

Director of Quality Management & Regulatory Affairs

•Coordinate and attend all Medical Staff Committee meeting and all pertinent hospital committee meetings where monitoring functions and activities are performed.

•Serve as a resource for Medical Staff and internal services on quality improvement activities, education, and use of quality principles and tools.

•Coordinate the process of monitoring, measuring, and assessment of patient care and support of systems to achieve high quality, safe, cost effective healthcare services.

•Coordinate and oversee hospital Quality Improvement Plan development, review, revision, and implementation.

•Coordinate and integrate QI plans and processes for individual services

•Coordinate and report Medical Staff Quality Assurance/Improvement activities.

•Coordinate and manage Core Measures reporting and other functions.

•Collects and reports HCAHPS data for the facility functions.

•Facilitate CQI teams as requested. Facilitate planning sessions as requested.

•Coordinate facility wide compliance with regulatory agencies.

•Departmental oversight, payroll, budgets, education, schedules, supplies, policies, procedures, job descriptions, Patient Safety, Patient Rights, Risk Management, Utilization Review, Credentialing, Medical Staff, Performance Improvement and Infection Control.

•Share administrative call, participate in Executive Team duties and Leadership Team responsibilities. Act as chief administrative officer in the absence of the CEO and CFO.

•Claims management and Incident Reporting - oversight of the event and incident reporting systems, analyzes and respond to reports, compile summaries of reports, report potential claims to carriers, review patient/family/physician complaints for liability risk and resolution.

•Program Administration - Develop, coordinate, and administer hospital wide systems for risk identification, investigation and reduction, maintain statistics, ensure that pertinent patient data relative to a claim is accurate, available, and secure. Review and coordinates trend analysis, claims profiles, worker's comp trends, and analysis of risk data. Advise security on loss reduction of property and assets. Develop, review and revise policies and procedures related to Risk Management.

•Legal Interface - Work with hospital legal counsel to coordinate the investigation, processing, and defense of claims. Respond to professional liability and hospital liability questions and maintain knowledge of legislative and regulatory activities related to health care risk management.

•Education - Provide in-service training to enhance awareness of employee's role in reducing liability exposures. Disseminate information on claim patterns and risk control, legislative and regulatory changes.

•Prepare Patient Safety, Patient Rights/Guest Relations, Credentialing, Medical Staff, Accreditation, Board Reports, Infection Control, Utilization Review and Performance Improvement of all departments.

•Provide consultations to departments to help in the design and implementation of Departmental policy and procedures and receive reports from all departments and provide some oversight of all departments through the Hospital-Wide Performance Improvement Program.

•Assist the leadership in various projects such as Chronic Disease Management.

•Ensure compliance with Clinical Regulatory Requirements and prepare the facility for survey readiness of voluntary and regulatory accreditation bodies.

•Maintain documentation of complex problems relating to quality and accreditation standards, initiate problem solving process and complete various projects.

•Incorporate patient safety goals and sentinel events alerts into the Performance Improvement and Patient Safety Programs.

•Maintain strong communications with clinical and administrative leaders to promote cooperation and provide leadership in new system development to improve care.

•Provide continuous education to staff regarding performance improvement and update staff on trends of quality indicators and area with opportunity for improvement.

•Serve as a consultant for both clinical and administrative staff on process improvement and quality care.

•Responsible for all hospital operations during duties as Administrator of the Day.

NYCHHC Woodhull Hospital/SUNY-Downstate Hospitals, New York NY September 1999-December 2003

Quality & Regulatory Compliance Consultant (evening and week end job)

Through: White Glove Agency, Inc (1999) and B&G Nurse Registry Inc (2001-2002)

•Provide consultations for TJC survey preparation.

•Create chart review tool/database.

•Create Board Report and Minutes templates to be used in Quality Management to monitor patient care.

•Provide chart review for legal affairs, risk management, utilization management activities and for the Center for Medicare and Medicaid compliance.

Workmen’s Circle Multi-Care Center, New York, NY October 1997-January 1999

Director of Infection Control

•Report to the associate executive director.

•Responsible for the planning, developing, directing, implementing and evaluating of the infection prevention and control activities within the heath care center.

•Work as a member of the committee of hospital, supporting the Medical Director.

•Serve as the leader of the infection control team.

•Supervise the infection control services for patients, visitors and staff.

•Conduct the regular rounds in hospital departments.

•Discuss and follow the practices of infection control with staff people.

•Collect the data on infections from the facility departments and maintaining records.

•Responsible for conducting the training sessions to ensure constant implementation of infection control practices.

•Conduct the continuous surveillance for detecting the infection source for the purpose of prevention.

•Follow the investigation of the incidents of the facility infections, generating reports and reporting them to Associate Executive Director and the Director of Nursing.

•Ensure the availability of supplies and place needed for isolation.

•Implement the educational programs for the provision of skills and knowledge.

•Implement the programs related to the infection preventive measures and control practices to ensure a safe environment or surroundings to patients, visitors and staff.

•Monitor the execution of preventive measures and provide guidance to staff properly.

•Take part actively in the unit meetings, in-service education programs, and quality improvement initiatives.

•Participate in the infection control team meetings.

•Responsible to report the infection outbreaks directly to the Associate Executive Director and the Director of Nursing.

•Responsible for preparing monthly statistical information for presentations in infection control meetings.

•Make sure that the staff is free from any infectious disease.

•Initiate emergency, fire safety measures, and safety practices as necessary.

•Direct the program and staff of the wound care services.

•Develop and implement wound care services in accordance with the policies of the hospital and the directives of the medical staff.

•Conduct weekly wound care rounds with wound care team and ensure that residents receive orders and treatment for their pressure ulcers.

•Monitor patient progress and treatment plans.

•Responsible for the education of clinical staff regarding wound care.

•Update the managerial staff and leadership on new regulations.

•Perform regular inspections and share reports with the managerial staff and leadership for corrective action.

•Ensure that the staff is prepared for regulatory surveys.

North Central Bronx Hospital/NYC Health & Hospital Corp. New York, NY January 1996-September 1997

Coordinating Manager/ Utilization Management/ Case Management

•In this acute care hospital provide Utilization Review services through coordination of multi-disciplinary services to improve patient care and reduce length of stay.

•Design some of the utilization review policies.

•Update and revise the Utilization Management/ Case Management Program.

•Provide chart review and communicated information to insurance companies to ensure reimbursements.

•Review denials and prepare review reports and communicate with insurance companies for reimbursement.

•As assigned, provided chart review in Risk Management.

Metropolitan Hospital/NYC Health & Hospital Corp. New York, NY January 1995-December 1995

Health Care Program Planner Analyst (HCPPA)/ Infection Control

•In this acute care hospital, participate in all infection control activities and provided chart review to detect actual and potential HIV/TB patients in order to maintain surveillance.

•Place patients on isolation as needed.

•Educate staff about Infection Control policies and procedures.

•Conduct daily rounds in the facility.

•Review Labs reports daily to identify patients with systemic signs of infection and make follow up to identify nosocomial cases.

•Create Infection Control reports for monthly meetings, the Medical Staff meeting, the Executive Quality meeting and the Quarterly Board Report.

•Conduct chart review for Quality Management, Risk Management and Utilization Management purposes.

Boston University Master in Public Health Program January 1993-December 1994

Master in Public Health Program

Received M.P.H. (Master in Public Health) degree.

Department of Public Health, Port-au-Prince, Haiti December 1991-December 1992

Attending Physician/ Preventive Medicine Department

•Provide medical exam to patients coming to the Preventive Medicine department for prenatal care, immunization and regular visit.

•Place orders for lab work and medication as necessary.

•Provide follow up and follow patient course up until discharge.

Ministry of Public Health, Port-au-Prince, Haiti September 1991-December 1992

Physician Public Health Advisor

•Assist and advise the Minister of Health, as member of the cabinet and participated in budgetary allocations, in the assessment, design/planning, implementation and evaluation of Priority Programs, including Infectious Disease Control and Prevention, Maternal and Child Health and Health Education and Promotion.

Bernhardt Nocht Institut, Hamburg, Germany January 1990-August 1991

Infectious Disease Physician: Post-graduate studies in Tropical Medicine and Medical Parasitology.

•Provide medical exam to patients admitted to the facility in the Infectious Disease Station.

•Place orders for lab work and medication.

•Work with the nursing staff and other staff involved in patient care.

•Provide follow up and follow patient course up until discharge.

•Refer patients to other specialists as necessary.

Education

JD, Juris Doctorate, Health Law, Concord Law School, Los Angeles, CA (2009)

MPH, Master of Public Health, Health Services Administration, Boston University, Boston, MA (1999)

MD, Doctor of Medicine, State University of Haiti, Port-au-Prince, Haiti (1989)

RN, Currently enrolled in the RN program at Azure College, Miami, Florida

Certifications

•CPHQ, Certified Professional in Healthcare Quality (2001)

•CHCQM, Certified Healthcare Quality Management from ABQAURP, American Board of Quality Assurance & Utilization Review Physicians, Risk Management specialization (2002)

•AAWM, Certified in Wound Care, American Academy of Wound Management (1997)

•CIC, Certified in Infection Control (1999)

•Diploma, Risk Management, New York University, New York, NY (2000)

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