Job Details

Compliance and Quality Improvement Specialist

Position Number: 6569355
Location: Salt Lake City, UT
Position Type: Assessment, Accreditation, and Compliance

Compliance and Quality Improvement Specialist

Job Summary

The Compliance and Quality Improvement Specialist is a member of the ambulatory operations team responsible for pediatric sub-specialty clinical services. This position reports to the Director of Ambulatory Operations. Under minimal supervision, responsible for assisting division leadership and clinical support staff in ensuring quality patient care and compliance with State Rules and accreditation requirements through quality improvement (QI) program design, and data collection, analysis and presentation. Acts as a catalyst between the department and its customers and staff to ensure continuity and quality of service and care. Promotes sound operational practices using a variety of communication strategies, process efficiencies, training programs, and data-based metrics. Works collaboratively with Department leadership, Primary Children's Hospital (PCH), and physician faculty members.

Works closely with ambulatory operations leadership and business analysts across 13 ambulatory clinics in the department of pediatrics. Monitors compliance and provides education to divisions and their clinical support staff. Works with divisions to give education on new compliance requirements, quality measures, and quality goals.

The ambulatory group in the Department consists of 13 pediatric subspecialty divisions and service lines that practice primarily at Primary Children's Salt Lake Campus, Primary Children's Riverton, Primary Children's Layton, Primary Children's Lehi (Miller Campus), and various satellite clinics. The pediatric ambulatory clinics at Primary Children's operate in site-of-service 11 and site-of-service 22 space that is used in conjunction with PCH and other University and community pediatric providers.

The Department of Pediatrics is the second largest department in the University of Utah School of Medicine and one of the largest pediatric departments in the country. We are committed to improving the lives of children through excellence in advocacy, education, research, and clinical care. For more information about the Department of Pediatrics, please visit: http://medicine.utah.edu/pediatrics/. Mutual respect and appreciation are highly valued in the department.

The University of Utah offers a comprehensive benefits package including:

Excellent health care coverage at affordable rates
14.2% retirement contributions that vest immediately
Generous paid leave time
10 paid Holidays per year
50% tuition reduction for employee, spouse, and dependent children
Flex spending accounts
Free transit on most UTA services
Employee discounts on a variety of products and services including cell phones & plans, entertainment, health and fitness, restaurants, retail, and travel
Professional Development opportunities

Additional benefits information is available at www.hr.utah.edu/benefits

Responsibilities
Essential Functions

Designs QI studies, develops criteria for evaluation, and assists divisions with appropriate data collection and data analysis.
Reviews and interprets patient care information, discharge summaries, operation reports, and other data sources used to assess quality care issues.
Creates reporting documents for divisions to use for tracking QI activities, trends and patterns, and identifying opportunities for improvement.
Provides education on data analysis and utilization of information to clinical teams.
Facilitates division and department QI meetings, providing "expert" input regarding problem identification and resolution, continuous quality improvement (CQI), and other patient care and accreditation activities.
May provide ongoing clinical support to divisions by reviewing and logging charts and incident reports and recording improvement activities and results.
Monitors daily QC, performs weekly and monthly QC and tracks/manages completion of vendor performed periodic maintenance on all laboratory equipment.
Oversees inventory control for supplies and reagents. Monitoring supply levels, ordering, tracking vendors, receipt and verification of incoming supplies, quality release into usable inventory and restocking work areas.
Assists the clinic managers and the director of ambulatory operations in tracking and trending Quality Indicators, writing and executing validation plans and SOPs, deviation management, root cause analysis, carrying out CA/PA and other Quality Assurance duties as dictated by management.
Tracking and ad hoc work on institutional goals and priorities
Routine check ins with divisions for feedback to generate initiatives
Works with the safety committee and helps carry out tasks with the safety committee
Help establish a hospital based (SOS 22) injection clinic
Evaluates Epic EMR optimization and provides training and education to providers and clinical support staff.

Problem Solving

Knowledge of "Quality Improvement" ideals with experience in a quality program (problem identification/investigation, root cause analysis, CA/PA).
Excellent written and verbal communication skills and attention to detail.
Demonstrated human relation and effective communication skills.
Ability to perform the essential functions of the job as outlined in the position description.
Current knowledge of State and accreditation regulations.

DisclaimerThis job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
The above job description reflects the general physical and mental demands and environmental conditions required to perform the essential functions for this position. Nothing in this job description restricts management's right to assign or reassign duties to this job at any time. The University of Utah Health complies with the Americans with Disabilities Act, as amended and Sections 503 & 504 of the Rehabilitation Act, and extends reasonable accommodations to qualified applicants or employees with disabilities. A qualified applicant must be able to perform the essential functions of the job, with or without a reasonable accommodation.
The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
Knowledge / Skills / Abilities
Knowledge of "Quality Improvement" ideals with experience in a quality program (problem identification/investigation, root cause analysis, CA/PA).
Excellent written and verbal communication skills and attention to detail.
Demonstrated human relation and effective communication skills.
Ability to perform the essential functions of the job as outlined in the position description.
Current knowledge of State and accreditation regulations.

Minimum Qualifications
Required
Bachelor's degree in a health care field or equivalency (one year of education can be substituted for two years of related work experience).
Two years of clinical or related hospital experience.

Preferred
A current Utah License to practice nursing.

Preferences

Special Instructions

Requisition Number: PRN43101B
Full Time or Part Time? Full Time
Work Schedule Summary: Monday - Friday, 8:00 am - 5:00 pm
Department: 00848 - Pediatric Administration
Location: Campus
Pay Rate Range: $74,425 - $95,306
Close Date: 12/12/2025
Open Until Filled:

To apply, visit https://utah.peopleadmin.com/postings/188807