Manager Quality & Accreditation

About the Company

CARE Hospitals Group is committed to providing high-quality healthcare services. Our mission is to meet patient care needs through continuous quality improvement and a culture of excellence.

About the Role

The role involves maintaining and reviewing departmental policies, coordinating quality improvement projects, and ensuring compliance with NABH accreditation standards.

Location: Bhubaneshwar

Responsibilities

• Maintain and review departmental policies, objectives, and procedures in association with the departmental HODs.
• Co-ordinate the planning, design, and implementation of Continuous Quality Improvement projects to systematically evaluate and meet patient care needs.
• Review and monitor data analysis of all quality indicators for each department and provide appropriate feedback to the concerned departments and to the top management through the Vice President-Quality & Operations of CARE Hospitals Group.
• Prepare and present regular reports on all departmental activities to the Hospital Chief Operating Officer & the Vice President-Quality & Operations.
• Conduct and oversee internal audits and provide appropriate feedback to the departments.
• Co-ordinate with NABH secretariat Office and NABH Assessors (in Accreditation process) for all communications.
• Organize, facilitate, and participate in NABH accreditation team evaluation visits to different departments of the organization during pre-assessment or reaccreditation.
• Conduct surprise audits along with the quality team and submit the reports to the management through the Vice President-Quality & Operations.
• Assist the Vice President-Quality & Operations in planning and conducting audits by external agencies for the purpose of accreditation.
• Strive to maintain NABH and other NABH certification requirements.
• Prepare the department’s annual reports for submission to the Hospital’s Facility Chief Operating Officer through the Vice President-Quality & Operations of the Group.
• Represent the department in committees of the hospital.
• Ensure NABH application is filled online (accreditation/re-accreditation) and all the data required for the application shall be coordinated.
• Ensure all the relevant documents are uploaded on the NABH website as and when required.
• Coordinate with NABH secretariat office for any queries/issues to be addressed.
• Ensure internal communication with the staff about the accreditation process through HCOO's office.
• Maintain contact with the assessment team and coordinate for their travel and stay.
• Ensure that closure is submitted to NABH after the completion of the assessment process well within the stipulated time frame.
• Ensure that the quality indicators report is submitted to NABH.
• Assume any other responsibilities as delegated by the Vice President-Quality & Operations or Hospital Chief Operating Officer.
• Follow up on issues raised by external and internal audit reports.

Qualifications

Relevant educational qualifications in healthcare management or a related field.

Required Skills

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Experience in quality management and accreditation processes.

Preferred Skills

• Familiarity with NABH accreditation standards.
• Experience in conducting audits and quality assessments.

Pay range and compensation package

Competitive salary based on experience and qualifications.

deepti.modani@carehospitals.com

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