Requirements§ Bachelor's Degree - REQUIRED§ Bachelor's / Master's Degree in Nursing, Public Health, Business Administration, Science, and Art - PREFERRED§ Three (3) to five (5) years of experience in healthcare management or healthcare education.§ Prior healthcare industry experience, especially in the areas of quality or regulatory management, project management and/or change management.§ Current New York State Licensed Registered Professional NurseCPHQ / Lean Six Sigma Certified - PREFERREDStrong knowledge of data reporting procedures by the Joint Commission, IPRO, Department of Health and National Data Nursing Quality Improvement (NDNQI).Job DescriptionThe Director of Magnet and Nursing Excellence has the overall accountability for developing and sustaining a culture of excellence and the components of Magnet Recognition Program in all areas where nursing is practice at The Brooklyn Hospital Center. This includes meeting the requirements of regulatory agencies and professional practice standards. Participates in hospital-wide committees as the designee of the Senior Vice President, Chief Nurse Executive.Provides expert knowledge of current Magnet Recognition Program requirements, regulatory requirements and quality initiatives. Works with the senior team to assess, plan, implement, evaluate, and coordinate structures and processes required to meet the requirements of the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program. Collaborates with nursing leadership and clinical nurses to identify opportunities for ongoing nursing excellence, thereby, achieving full compliance with Magnet Program requirements, and other state, federal and regulatory agencies. Promotes inter-professional collaborative relationships among health care professionals and coordinate committees, task forces, meetings, and activities related to quality and the Magnet Recognition program. Implements organization-wide communication plan on ANCC's Magnet Recognition ProgramAssists with the development, implementation, and evaluation of the nursing department's overall quality improvement (QI) and regulatory program. Identify, monitor and evaluate trends, prioritize and recommend improvements, decrease duplication, and ensure Joint Commission on Accreditation of Healthcare Organizations (JCAHO) compliance. Supports nursing and its leaders and staff to ensure full compliance with state licensure regulations, hospital conditions of participation, and accreditation standards. Actively participates and leads the organization's efforts to prepare for, take part in, and respond to any necessary follow-up of both announced and unannounced regulatory body site visits. Responsibilities also include informing staff regarding hospital accreditation and licensure standards and regulations. Actively works with policy owners to facilitate policies compliant with regulatory bodies.Provides regulatory consultation for internal customer projects to ensure that they are consistent with the regulations. Develops, maintains, and documents in requisite databases in order to track activities and ensure continuous process improvement and efficiency within the organization and department. Demonstrates understanding of concepts, methods, techniques and principles needed to accomplish job responsibilities such as NY DOH, The Joint Commission (TJC) and Center for Medicare and Medicaid Services (CMS) regulations.
