Position Location:

Hospital for Special Care

Scheduled Weekly Hours:

40

Work Shift:

First Shift

Department:

Administration

We are dedicated to creating an environment of care and engagement that makes us one of the most desirable places to work, providing exceptional care to each patient each and every day!

Qualifications

Education: Master’s degree required (Healthcare Administration, Nursing, Public Health, or related field)

Licensure/Certification:

• Relevant clinical license
• CPHQ strongly preferred
• CPHRM preferred

Experience:

• 7–10 years of progressive leadership in healthcare quality
• Experience in LTCH, acute care, or post-acute settings
• Demonstrated success in regulatory compliance and quality improvement

Position Summary

The Vice President of Quality is a senior leader responsible for the execution and operational leadership of quality, patient safety, regulatory compliance, risk management, accreditation readiness, emergency preparedness, and clinical contract performance within the hospital.

Reporting to the COO, this role partners closely with operational and clinical leaders and the Director of Quality and Risk to identify opportunities, implement strategies, drive measurable improvements, and ensure sustained compliance. The VP serves as the primary operator of the quality infrastructure, translating organizational priorities into actionable programs and outcomes.

Physical Demands

• Job requires periods of walking, standing and prolonged sitting.
• Job involves carrying of documents, books, chairs and small equipment (i.e. laptops.)
• Job requires frequent keyboarding and telephone use.
• Reaching and bending as related to accessing file drawers and shelves for documents.
• Positions would be sustained for not greater than 60 minutes

Cognitive Demands

• The position requires a command of the mission and goals of Center and its affiliates and what must be done to satisfy the goals
• Position requires independent problem identification, abstract reasoning and adaptability.
• Quick decision-making on issues with significant organizational impact is required.
• A high degree of selective attention, discernment, perception and concentration is necessary.
• The ability to multi-task and to move fluidly from topic to topic, including shifting from strategic topics to very tactical actions in the course of the day is required.
• Position requires a high degree of writing proficiency and attention to detail, adherence to all elements of style and ability to express self clearly.
• Position requires a high level of communication skill including expression of abstract/ complex ideas, ability to convey ideas and vision, use of negotiation, active listening and the ability to dialogue with multiple parties. Involves the use of skillful influencing, flexibility, patience and creativity to approach issues in a manner that the business can digest and manage.
• Position requires reading and auditory comprehension of abstraction and an ability to make inferences.

Work Demands

• The position works in a pleasant climate-controlled environment.
• The position requires flexibility that is required for this type of independent work.
• This process-driven atmosphere requires the ability to function effectively during periods, which may be considerably stressful.
• Frequent schedule changes and irregular working hours to accommodate fluctuations in business needs is expected.
• Position requires off hours on call (Risk and AOC).

 Essential Functions

Quality & Patient Safety Execution

• Lead implementation of the organization’s quality and patient safety strategy under COO direction.
• Drive performance improvement initiatives targeting:
  • Hospital-acquired conditions
  • Readmissions
  • Falls, infections, pressure injuries, and adverse events
• Utilize data analytics to identify trends and implement evidence-based interventions.
• Lead RCA, FMEA, and event review processes with actionable follow-through.

Risk Management Operations

• Manage day-to-day clinical and regulatory risk management activities.
• Oversee incident reporting systems, ensuring timely investigation and resolution.
• Coordinate with legal, compliance, and insurance stakeholders on claims and risk exposure.
• Implement proactive risk reduction strategies within workflows and policies.

Accreditation, Regulatory & Licensure

• Lead survey readiness activities including mock surveys and audits.
• Ensure compliance with CMS, Joint Commission, and state regulatory requirements.
• Manage plans of correction and sustain compliance improvements.
• Oversee licensure documentation, renewals, and regulatory reporting processes.

Emergency Preparedness Program Management

• Operationalize the Emergency Preparedness Program in alignment with CMS requirements.
• Coordinate drills, exercises, and after-action reviews.
• Maintain emergency operations plans and hazard vulnerability assessments.

Clinical Contracts & Vendor Performance

• Monitor quality and safety performance of clinical vendors and contracted services.
• Track SLAs, performance metrics, and outcomes.
• Collaborate with operations and finance to evaluate contract effectiveness and risk.

Leadership & Collaboration

• Serve as a key member of the leadership team supporting the COO.
• Collaborate with clinical, operational, and medical staff leaders to drive improvement.
• Lead and develop quality and risk management teams.
• Engage physicians in peer review and quality initiatives.

Core Competencies

• Regulatory and accreditation expertise
• Data-driven performance improvement
• Risk management and patient safety
• Operational execution
• Change management
• Collaboration and physician engagement

Key Performance Indicators

• CMS quality performance and benchmark achievement
• Accreditation and survey readiness outcomes
• Reduction in adverse events and safety events
• Timeliness and effectiveness of corrective actions
• Clinical vendor performance
• Education compliance and competency completion rates

Position Impact

This role ensures the effective execution of the organization’s quality and safety infrastructure, supporting the COO’s overarching accountability for quality, compliance, and operational excellence.

Compensation & Benefits

At Hospital for Special Care, we are committed to supporting the health, financial well-being, and professional growth of our team members. The wage range for this position is $__214,000___ to $  279,000__. Eligible employees may participate in a comprehensive benefits package that includes employer-subsidized medical and dental, vision insurance; a 403(b) retirement savings plan with an employer match of up to 6%; paid time off; employer-paid life insurance; short-term and long-term disability insurance; a Health Savings Account (HSA) with employer contributions; Flexible Spending Accounts (FSA); an Employee Assistance Program (EAP); tuition reimbursement and professional development opportunities; voluntary benefits, including pet insurance; employee wellness programs with access to our onsite fitness and aquatics center; an employee referral bonus program; and meaningful employee recognition and appreciation initiatives. Eligibility for certain benefits is based on scheduled hours worked.