Clinical Quality Improvement Director

Job Description

Join Hilo Benioff Medical Center and be part of a team that proudly cares for our friends, family, and neighbors across East Hawaiʻi.

Hilo Benioff Medical Center, the acute care center for East Hawai'i, is hiring a Clinical Quality Improvement Director to lead quality, patient safety, and regulatory readiness across our acute care, hospital-based long-term care, and ambulatory services.

This role is built for someone genuinely fluent in quality data. You will own our data inventory across all quality reporting measures. You will build and validate the reporting yourself and you will be able to trace any result back to the documentation that produced it.

You will participate in the QAPI program, maintain continuous survey readiness, lead patient safety and RCA work, partner with CDI on risk-adjusted outcomes, and supervise the Quality Department. This position reports to the Regional COO with direct board visibility.

This role is fully in-person, based at Hilo Benioff Medical Center.

• Direct hospital quality and regulatory compliance, ensuring adherence to CMS Conditions of Participation, Joint Commission standards, State of Hawaii requirements, and applicable acute care, critical access, and long-term care regulations.
• Lead quality measurement and reporting, including interpretation of hospital quality measures, specifications, exclusions, risk models, and reporting requirements, while understanding their impact on reimbursement, public ratings, and organizational reputation.
• Analyze and interpret clinical and operational data, independently acquiring, validating, joining, and analyzing data; developing measurement methodologies; and using advanced spreadsheets and business intelligence tools such as Tableau or Power BI.
• Leverage Epic and clinical informatics capabilities to extract and evaluate reportable clinical data, develop report specifications, and collaborate with Informatics, IT, and clinical leaders to improve documentation and data capture at the point of care.
• Lead multidisciplinary quality improvement and care transformation initiatives, using data and evidence-based practices to identify opportunities, facilitate performance improvement, communicate results, and drive sustainable improvements in patient care.
• Provide strategic leadership and professional oversight, supervising and developing quality and analytics staff, influencing clinical and medical staff without direct authority, exercising sound judgment with confidential and peer-review information, and working effectively with the communities served by the East Hawaii Region.

• Bachelor's degree in Healthcare Administration, Public Health, Healthcare Analytics, Nursing or related field;
  Master’s degree preferred
• Eight (8) years of progressively responsible work experience in a healthcare setting, including:
  • At least four (4) years working a healthcare quality department. Such work must have involved participation in the development of policies and procedures to meet State, Federal and other agencies.
  • At least three (3) years of experience in an acute hospital environment
  • At least two (2) years of experience as a supervisor. This includes work experience which demonstrated the applicant's knowledge of and ability to apply the principles, practices, techniques and methods of supervision including: (1) planning, organizing and directing the work of others; (2) assigning and reviewing work; (3) advising others on difficult work problems; (4) timing and scheduling work; and (5) training and developing employees.
• Certified Professional in Healthcare Quality (CPHQ), or the ability to attain the certification within twelve (12) months of appointment.

Preferred Qualifications: Epic…