Job Title: Clinical Excellence Coordinator Division: Health Center
Reports To: Director of Nursing Department: Nursing
FLSA Status: Exempt Effective Date: 4.1.2026
Position Summary
The Clinical Excellence Coordinator ensures that clinical care is high-quality, consistent, compliant, and continuously improving. The role blends clinical oversight, quality improvement, education, and regulatory compliance.
Supervisory Responsibility
This position has supervisory responsibilities
Duties and Responsibilities
Clinical Quality & Outcome Oversight
- Monitor, analyze, and trend Quality Measures (QMs), five-star data, and community benchmarks
- Lead Quality Assurance and Performance Improvement (QAPI) initiatives
- Conduct root cause analyses for adverse events such as falls, infections, weight loss, pressure injuries, rehospitalizations
- Develop and implement corrective action plans with measurable outcomes
- Track effectiveness of interventions and adjust strategies accordingly
Regulatory Compliance & Survey Readiness
- Conduct routine clinical audits in areas such as documentation, infection control, med pass, care plans, and other high-risk areas
- Ensure compliance with CMS, state regulations, and community policies
- Lead mock surveys and maintain ongoing survey readiness
- Review and update policies and procedures to align with regulatory standards
- Collaborate with leadership in response to citations and Plans of Correction
Clinical Leadership
- Support the Director of Nursing in daily clinical operations
- Provide clinical oversight and mentorship to nursing staff members
- Assist with staffing oversight, clinical competency validation, and skills fairs
- Participate in investigation of incidents, grievances, and reportable events
- Provide education to staff members based on identified trends or regulatory updates
Performance Improvement Implementation
- Identify systemic gaps impacting resident outcomes
- Develop standardized tools, workflows, and accountability systems
- Facilitate interdisciplinary performance improvement meetings
- Promote evidence-based practice and clinical excellence culture
- Drive data-informed decision making at the unit level.
Required Skills/Abilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
- Willingness to uphold Snyder Village Mission and Values
- Professional demeanor and excellent communication skills, both verbal and written, with tact, enthusiasm, and the ability to handle difficult situations with staff members, residents, family members, visitors, and the public
- Demonstrate problem-solving and critical thinking skills, with the ability to assess situations and implement effective, resident-centered solutions
- Strong clinical skills, knowledge of CMS regulations and 5-Star methodology, experience analyzing data and working on sustainable improvement plans, knowledge of MDS and Medicare and managed care reimbursement.
- Must recognize the value of providing extraordinary customer service and value person centered care
- Leadership skills with the ability to supervise, coach, and train staff
- Maintain confidentiality of information and conversations, including resident information
- Strong organizational and follow-up skills
- Ability to work and make good decisions independently
- Proficient computer skills
- Ability to work occasional evenings or weekends for events
Physical Requirements:
- Sits, stands, bends, lifts, and moves intermittently during working hours
- Frequent interruptions
- Interact with staff members, residents, families, and other visitors under all conditions and circumstances
- May be required to work beyond normal working hours, on weekends, and temporarily in emergencies and/or to ensure proper care for all residents
- Ability to lift up to 50 lbs.