Director of Quality, Patient Safety & Risk Management – Acute Care

Our client is seeking a Director of Quality & Risk to lead all hospital‑wide Quality, Patient Safety, Performance Improvement, and Risk Management functions. This leader ensures continuous regulatory readiness, drives clinical excellence, and partners with senior leadership to improve patient outcomes and reduce organizational risk.

This role requires a seasoned clinical leader with deep experience in quality improvement, accreditation, and risk mitigation within an acute‑care healthcare environment.

Onsite | No Visa Sponsorship | Relocation Assistance: Limited or negotiable based on candidate experience

Responsibilities:

Quality & Performance Improvement

• Lead the development, implementation, and evaluation of the hospital's Quality and Performance Improvement (PI) program.
• Integrate evidence‑based practices into clinical and operational workflows.
• Oversee quality metrics, dashboards, and data reporting for internal and external stakeholders.
• Facilitate RCA, FMEA, and other PI methodologies, ensuring action‑plan execution and follow‑through.

Regulatory & Accreditation

• Maintain continuous readiness for state, federal, and accreditation surveys (Joint Commission, CMS Conditions of Participation)
• Coordinate survey preparation, mock surveys, corrective action plans, and ongoing compliance monitoring.
• Serve as the subject‑matter expert on regulatory standards and quality requirements.

Risk Management & Patient Safety

• Oversee the hospital's risk management program, including incident reporting, investigation, documentation, and follow‑up.
• Identify trends, develop mitigation strategies, and collaborate with leaders to reduce organizational risk.
• Support patient safety initiatives, safety culture development, and proactive risk assessments.

Leadership & Collaboration

• Lead and mentor Quality, Risk, and Patient Safety teams.
• Foster a culture of accountability, transparency, and continuous improvement.
• Partner with clinical and operational leaders to improve care delivery and patient outcomes.
• Present quality and risk data to executive leadership, medical staff committees, and the Board.

Operational & Administrative

• Develop departmental goals, policies, and performance standards.
• Manage departmental budgets, staffing, and resource allocation.
• Coordinate internal and external audits and ensure timely completion of corrective actions.
• Maintain confidentiality and ensure compliance with HIPAA and organizational policies.

Qualifications (Must-Haves)

• Active RN license.
• Strong analytical, communication, and leadership skills.
• Master's degree in Nursing or another healthcare‑related field.
• 5+ years of leadership experience in healthcare quality, risk management, patient safety, or nursing leadership.
• Demonstrated experience with regulatory compliance, accreditation readiness, and PI methodologies.

Preferred Skills:

• CPHQ, CPPS, or risk‑related certification.
• Experience in an acute‑care hospital setting.
• Familiarity with Lean, Six Sigma, or other PI frameworks.