PACE QUALITY AND COMPLIANCE DIRECTOR
REPORTS TO: PACE Program Director and PACE Medical Director
POSITION REQUIREMENTS:
- Education equivalent to at least an Associate's Degree form an accredited college with a degree in nursing, or related field or equivalent applicable education, experience, and/or training. Prefer Bachelor's Degree in a health-related profession from an accredited institution or graduate from an accredited nursing program with experience in quality assurance.
- Prior experience in applying quality assurance principles and participating in quality assurance programs.
- Demonstrated clinical experience in a variety of healthcare settings.
- Computer experience with proficiency in excel and PowerPoint.
SUMMARY: The Quality and Compliance Director is responsible for the coordination and implementation of quality improvement activities; monitoring quality of services and care issues of Program for All-inclusive Care for the Elderly (PACE) participants; developing action plans for performance issues; communicating quality assurance activities and outcomes with staff; ensuring compliance with all federal and state regulations to maintain program excellence.
DUTIES AND RESPONSIBILITIES:
- Ensures staff and contracted personnel have knowledge of Quality Improvement and share data regarding QI activities with them.
- Develops and implements a strategic comprehensive quality assurance and risk management program based on key PACE program processes/services to facilitate an efficient and cost-effective, low risk healthcare organization.
- Produces data and reports on quality activities and performance and compliance.
- Ensures Board of Director Members are aware and have knowledge of current QI and Compliance activities; Presents QI Annual Report to the Board of Directors and conducts Compliance training with them.
- Assembles and analyzes data as information for Centers for Medicare & Medicaid Services (CMS)/National PACE Association (NPA)/Department of Medical Assistance Services (DMAS) reports as needed for the PACE Director.
- Monitors AASC's regulatory compliance and alerts PACE Director of possible deficits.
- Schedules and conducts quarterly compliance meetings and monthly quality meetings and maintains meeting minutes.
- Reviews and updates policies and procedures as needed.
- Conducts annual participant satisfaction surveys.
- Involves all staff in the QI program as owners of the program.
- Uses standard methodology to document and assess QI activities.
- Audits and/or maintains the Infection Control, Incident and Grievance Logs.
- Audits the service delivery requests log.
- Liaison with contracted vendor for the electronic medical record and trains and assists staff with usage.
- Assists staff in process review, critical indicator selection, and threshold levels.
- Involves PACE participants in the QI program.
- Develops systematic reporting to all components of the PACE program system (Staff, Board of Directors, Participant Advisory Committee, and Contractors).
- Performs chart audits to ensure completeness and accuracy.
- Compiles and submits data to AASC, CMS, DMAS, NPA as required or requested.
- Provides oversight of the PACE Emergency Safety Program and serves as PACE liaison to the AASC Safety Committee.
- Liaison to Audit Teams from CMS and DMAS, preparing documents prior to audit, assisting during audit, and responding to Audit reviews and corrective action plans.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of Quality Assurance principles and the ability to apply them to various situations.
- Ability to set objectives and develop action plans.
- Competent in identifying problems and developing effective solutions.
- Strong critical thinking skills.
- Orientation to detail and ability to see a broader picture.
- Communicate effectively orally and in writing.
- Possesses the skills to brief information to large groups.
- Proficiency in data and word processing applications.