QUALITY & COMPLIANCE COORDINATOR - PACE

Job Purpose

The Quality & Compliance Coordinator supports the PACE organization's efforts to maintain high standards of quality, regulatory compliance, and organizational integrity. This role assists with quality improvement initiatives, compliance monitoring, data reporting, and audit readiness to ensure adherence to CMS, DHCS, and state/federal regulatory requirements. The Coordinator works closely with the Quality/Compliance leadership, interdisciplinary team (IDT), and operational departments to promote participant safety, service excellence, and continuous improvement.

Duties and Responsibilities

Quality Improvement (QI)

• Assist in planning, implementing, and evaluating the organization's Quality Improvement Program.
• Collect, track, and analyze quality metrics, participant data, and performance indicators.
• Support QAPI projects, root cause analyses (RCA), and performance improvement plans.
• Maintain QI dashboards, logs, and documentation for internal use and external reporting.
• Coordinate and monitor corrective action plans (CAPs) and follow-up activities.

Compliance & Regulatory Support

• Support ongoing compliance monitoring to ensure adherence to CMS, DHCS, and state regulatory requirements for PACE programs.
• Assist with policy and procedure development, review, and revision.
• Track compliance deadlines, training requirements, audits, and reporting obligations.
• Conduct routine compliance audits, including personnel file reviews, encounter data monitoring, documentation review, and service tracking.
• Support oversight of vendor compliance and credentialing as assigned.

Audit Preparation & Monitoring

• Assist with preparation for internal and external audits (CMS, DHCS, HHS, internal compliance reviews).
• Maintain organized audit files, evidence documentation, and submission materials.
• Track audit findings and corrective actions to ensure timely resolution.

Incident Reporting & Risk Management

• Assist in intake, logging, tracking, and follow-up of reportable incidents, grievances, and participant complaints.
• Participate in investigations by gathering documentation and supporting the Quality/Compliance team.
• Prepare monthly and quarterly reports for committees and leadership.

Education & Training

• Assist in scheduling, documenting, and tracking mandatory trainings such as HIPAA, compliance, safety, and PACE-specific regulatory requirements.
• Participate in onboarding education related to compliance and quality expectations.

Committee & Administrative Support

• Provide administrative support for Quality Assurance/Performance Improvement (QAPI), Compliance, and Safety Committee meetings.
• Prepare agendas, take minutes, and track follow-up actions.
• Other duties as assigned.

Qualifications

Education & Experiences:

• Associate's or Bachelor's degree in Health Administration, Nursing, Public Health, Business Administration, or related field preferred.
• Minimum 2 years of experience in healthcare quality, compliance, managed care, or related field.
• Experience with PACE, long-term care, or regulatory programs (CMS/DHCS) strongly preferred.

Knowledge, Skills & Abilities

• Understanding of CMS and DHCS regulations governing PACE programs.
• Strong analytical and organizational skills with high attention to detail.
• Ability to interpret regulatory guidelines and apply them operationally.
• Excellent written and verbal communication skills.
• Proficiency in data tracking systems, Microsoft Office, and electronic health records (EHR).
• Ability to maintain confidentiality and adhere to HIPAA requirements.
• Ability to work collaboratively with cross-functional teams.

Other:

• Requires physical strength to perform the job.
• Routine travel between PACE sites and in the community required.
• Requires valid driver's license.

Physical Demands

• Must be able to remain in a stationary position 50% of the time.
• Ability to occasionally move about inside the office to access file cabinets, office machinery, etc.
• Able to operate a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.
• Able to constantly position yourself to maintain files in file cabinets such as reaching with hands and arms, kneeling, crouching, etc.
• The ability to communicate, detect, converse with, discern, convey, express oneself, and exchange information is crucial for this role.