The RN Quality & Infection Prevention Coordinator is responsible for leading, coordinating, and maintaining the facility’s performance improvement (PI), quality, and infection prevention programs. This role ensures compliance with regulatory standards, promotes patient safety, and drives continuous improvement through data analysis, education, and process evaluation.

This position works collaboratively with leadership, physicians, and staff to improve outcomes, reduce risk, and enhance overall quality of care.

1. Philosophy

- Supports the facility’s ideology, mission, goals, and objectives

- Performs in accordance with the facility’s policies and procedures

- Follows the facility’s standards for ethical business conduct

- Recognizes patients’ rights and responsibilities and supports them in performance of job duties

- Participates in facility committees, meetings, in-services, and activities

- Seeks out additional assignments and duties

2. Work Quality

- Performs duties in an accurate and organized manner

- Adheres to policies and procedures in performance of duties

- Ensures knowledge of job and asks questions when unsure

- Completes duties within appropriate timeframes

3. Personal Attributes

- Shows initiative and dependability including punctuality and attendance

- Displays good judgment

- Cooperates and is flexible

- Follows appropriate dress code presenting a professional image

4. Customer Service

- Fosters a culture of outstanding patient service showing courtesy in interactions with patients, physicians, co-workers, and vendors.

- Presents good telephone skills

- Responds promptly to patient needs and co-worker requests

5. Communication and Teamwork

- Expected to be a positive and responsible team member with a good attitude

- Presents good oral and written communication (documentation) skills

6. Professional Competence

- Participates in continuing education and other learning experiences

- Shares knowledge gained in continuing education with staff

- Maintains membership in relevant professional organizations

- Seeks new learning experiences by accepting challenging opportunities and responsibilities

- Welcomes suggestions and recommendations

7. Core Responsibilities

- Develop, implement, and maintain infection prevention program

- Conduct surveillance, collect and analyze infection data

- Investigate infections or potential outbreaks

- Monitor compliance with infection control policies and standards

- Lead exposure investigations for patients and staff

- Perform audits related to infection control practices

- Provide education and training to staff

- Maintain required documentation and reporting

- Coordinate and manage the Performance Improvement (PI) program

- Develop and monitor quality indicators and benchmarks

- Collect, analyze, and trend data to identify improvement opportunities

- Present findings and recommendations to leadership and committees

- Lead quality improvement initiatives and corrective action plans

- Conduct follow-up studies to evaluate effectiveness of improvements

- Promote a culture of safety and continuous improvement

- Data & Reporting

• Track and trend quality and infection control metrics

• Prepare and present:

• Quarterly reports

• Committee reports

• Governing body summaries

• Ensure data-driven decision making

- Committee Participation

• Lead or participate in:
• Infection Control Committee
• Performance Improvement Committee
• Present findings and action plans
• Collaborate with leadership on strategic improvements

- Education & Staff Engagement

• Provide ongoing staff education on:
• Infection prevention
• Quality initiatives
• Policy updates
• Engage staff in improvement efforts
• Serve as a resource for best practices

- Policy & Compliance

• Develop, review, and update policies related to:
• Infection control
• Quality and safety
• Ensure compliance with:
• AAAHC / accreditation standards
• State and federal regulations
• Participate in surveys and audits