Manager of Quality and Compliance

The PACE Quality and Compliance Manager leads the development, coordination, implementation, and oversight of PACE KC’s Quality Improvement program. In partnership with the Quality Committee, this role develops the annual Quality Plan and guides its execution. The manager ensures data is collected from appropriate sources, analyzed, and shared with stakeholders. This position also oversees the review and resolution of medical and non-medical grievances and appeals submitted by participants, family members, or representatives. In addition, the manager directs the Corrective Action Plan process for annual State and CMS audits to maintain regulatory compliance, supports team quality improvement initiatives, and serves as a local resource to clinical staff on staff and participant infection control matters.

Primary Functions

1. Manage all required quarterly and annual reporting to the Centers for Medicare and Medicaid Services (CMS), the State Administering Agency (SAA), and the PACE team, and monitor interventions to ensure regulatory compliance.
2. Conduct root cause and impact analyses as needed or at the request of CMS or the SAA.
3. Audit charts to ensure compliance with CMS and SAA regulations and confirm that documentation is accurate, complete, and aligned with the authorized care plan.
4. Audit the organization to prepare for surveys and ensure compliance with CMS, the SAA, The Joint Commission, and other regulatory agencies.
5. Identify areas of concern or opportunities for improvement to enhance participant satisfaction and health outcomes. This may include developing new protocols or policies and creating action plans to address deficiencies or improve care and service delivery.
6. Develop and guide the ongoing implementation of the annual Quality Improvement and Compliance Plan.
7. Promote staff involvement in the Quality Improvement process through continuous quality improvement education and opportunities for input.
8. Analyze risk management and quality improvement data to identify and, when appropriate, address instances of fraud, waste, and abuse.
9. Oversee the evaluation and resolution of medical and non-medical grievances and appeals submitted by participants or their representatives, and review findings to inform quality improvement initiatives and the annual Quality Improvement and Compliance Plan.
10. Lead PACE KC’s emergency and disaster planning, training, and implementation efforts.
11. Conduct annual satisfaction surveys of PACE KC participants and caregiver and report the findings.
12. Facilitate quality assurance communication among contract facilities, the PACE KC Interdisciplinary Team, and staff.
13. Advise and assist with contract facility orientation to support effective coordination of participant care
14. Participate in interdisciplinary team meetings by communicating participant changes, contributing to care planning decisions, and coordinating care delivery.
15. Participate in required in-service training and staff meetings.
16. Perform other duties as assigned.

 Supervisor Duties and Responsibilities

1. Hires, selects, directs, supervises, and evaluates the performance of direct reports. Handles discipline and termination, if necessary, of associates in accordance with policy.
2. Oversee the daily workflow of the department.
3. Ensure that the job responsibilities, authorities, and accountability of all direct reports are defined and understood.
4. Assist in providing in-service education for the PACE KC associates.

 Job Related Competencies

 Knowledge of quality management techniques and methods that measure and improve services and service delivery.

1. Knowledge of compliance and privacy laws and regulations related to health care systems.
2. Demonstrated effective leadership skills and decision-making skills.
3. Knowledge of physical, mental, and social needs of the elderly.
4. Have patience, tact, and willingness to deal with difficult residents and family members.
5. Excellent oral and written communication skills.
6. Effective interpersonal skills with ability to build relationships.
7. Effective organizational skills with attention to detail and time management skills.
8. Strong analytical and problem-solving skills.
9. Strong supervisory and leadership skills.
10. Proficient with Microsoft Office Suite or related software.
11. Proficient with Electronic Medical Records.

Qualifications and Experience

 Bachelor's Degree, or equivalent combination of education and experience in business administration and/or health and human services or related field is required.

1. (2) years of demonstrated experience in quality assurance and/or compliance in health-related
2. (1) year supervisory experience in a health-related field.
3. Medical clearance for communicable diseases and up-to-date immunizations, before having direct participant contact.

Certification & Licensure Requirements

 1. Current American Heart Association Basic Life Support (BLS) with Automated External Defibrillator (AED) certificate or the ability to obtain it.