Summary
This position aligns under the VA Maryland Health Care System (VAMHCS), Quality, Safety and Improvement Office, Quality, Performance, and Accreditation Section. The Administrative Performance Improvement (PI) Specialist position is located primarily in the Baltimore VA Medical Center (VAMC) but also supports Perry Point VAMC, Loch Raven VAMC and Community Based Outpatient Centers within the VAMHCS.
Duties
Major Duties Include: Coordinates and facilitates with service line SME's in the development, evaluation, facilitation, documentation, analysis and coordination of short term, mid-term, and long-range plans, programs, and performance improvement projects within VAMHCS to ensure compliance with regulatory standards associated with national accrediting organizations including but not limited to OIG, TJC and LTCI as well as compliance with National Fire Protection Association (NFPA), Life Safety Code, Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), and other regulations required and enforced by federal, state and local levels. The incumbent is responsible for providing consultation, recommendations, compliance information and data to their assigned services as well other services on an as needed basis. The services for which the incumbent is responsible include but are not limited to Facilities and Engineering, Human Resources Management, Acquisition & Materiel Management, Finance and Accounting, Police & Security, Public Affairs and Voluntary Service, Information Resource Management, Environmental Management Services, and Medical Administration Services. The incumbent will routinely perform administrative support Compliance Tracers using standard Tracer methodology, as directed by the Q, PI&A Director Tracers will be conducted to assess continuous survey/accreditation/regulatory body readiness. Findings will be documented and submitted, as required, to the Q, PI&A Director, the QSI Director, and any required committees or councils. In this role, the incumbent works with various leaders and service line SME's to ensure continuous survey/accreditation readiness for all supported organizations. The incumbent will be required to attend council, committee meetings, and work group meeting/discussions, concerned with the monitoring and evaluation of one or more aspects of Quality, Performance Improvement and Accreditation, as well as other organizational committees, councils, or WGs that are responsible for ensuring quality and appropriateness of VAMHCS healthcare operations for assigned Administrative type service lines. The incumbent serves as a technical and administrative Liaison, guide, and SME for preparations leading to and the actual conduct of surveys and accreditation/regulatory agency visits and inspections, assisting the Q, PI&A Director in overseeing the management and conduct of these visits and inspections. Provides guidance and technical assistance in overseeing or assisting in the development, implementation and maintenance of the PI program to evaluating the quality of care/service delivery, customer satisfaction with same and achievement of stated/defined performance measures/expectations/goals for the area or function to which they are assigned. Primary responsibility lies with the Administration SME's and/or Service Chief for the area in which the Specialist functions as advisor. The Administrative PI Specialist provides first line technical and administrative supervision to various VAMHCS personnel supported by the QSI Office. The incumbent is responsible for keeping employees informed regarding policies, procedures and management goals as they relate to the work of VAMHCS. The Administrative PI Specialist assists in the development and evaluation of the goals, priorities, and work of supported care centers, services, and departments in accordance with organizational goals. The Specialist assists supported leaders in understanding the requirements of the accreditation manuals relevant to their service/care center/department, and will assist in the development, direction and implementation of policies pertaining to the requirements of the various services/care centers/departments. Work Schedule: Monday-Friday 8am-4:30pm Telework: ADHOC Only Virtual: This is not a virtual position. Position Description/PD#: Health System Specialist/PD19058O Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized
Requirements
You must be a U.S. Citizen to apply for this job To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Selective Service Registration is required for males born after 12/31/1959 Subject to background/security investigation Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
Education
There is no educational substitution at this grade level. A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
How you will be evaluated
Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses on the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following Competencies for this position: Administration and Management Attention to Detail Customer Service Decision Making Flexibility Integrity/Honesty Interpersonal Skills Learning Planning and Evaluating Quality Management Reasoning Self-Management Stress Tolerance Teamwork Your experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.