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PACE Quality Coordinator

2 months ago

San Diego, United States San Ysidro Health Center Full time

Wednesday, August 21, 2024 Position Summary: Under the supervision of the Quality Assurance Supervisor and the Quality Manager, assist in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program. The Quality Assurance Coordinator will be responsible for data collection, management, and data submission in accordance with CMS, State, accrediting bodies, and the San Diego PACE. In close coordination with the QA Manager, assists with the investigation of incidents, grievances, appeals, potential quality of care concerns, and as assigned. Ensures grievances/complaints are processed in accordance with applicable state and federal regulations, compliance standards, and policies and procedures. The QA Coordinator will assist the QA Supervisor and QA Manager in the annual review and update of the quality improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, education and training of program staff around quality improvement, preparation of routine and special reports, and coordination of improvement efforts arising from monitoring activities. Essential Functions of the Job: Tracks real-time data and provides feedback to the Interdisciplinary team (IDT) by attending IDT meetings as assigned, to ensure quality, compliance, and safety elements are documented, including service delivery requests, grievances, appeals, ER visits, hospitalizations, Level I & Level II incidents, Falls, and other metrics as needed. Provides quality and compliance support to the IDT team. Guides the IDT and Center Manager on recognizing and documenting periodic participant assessments and care plans. Gathers data from a variety of sources and organizes it within spreadsheets and other software tools for analysis and interpretation. Assists with gathering all data for Level I reporting and enters data into the Health Plan Management System (HPMS). Analyzes PACE quality, compliance, and safety data, making suggestions when potential issues arise. Works with various departments and management to assist in addressing potential quality, compliance, and safety issues. Provides data entry within organizational data systems, as well as regulatory data systems of the State and Federal government. Prepares data for Quality & Compliance presentations as needed. Assists in the Plan-Do-Study-Act (PDSA) processes of Quality Improvement. Manages large data sets and organizes them into an interpretable format using Excel and other software tools. Assists in reporting to State and Federal regulators. Must be able to provide written and verbal communication with all staff, caregivers, participants, and the community at large. Ability to organize and manage large volumes of data. Must be detail-oriented and organized with excellent customer service skills. Demonstrates integrity, discretion, and practices objective problem-solving. Ability to collect, organize, and report meaningful data for decision-making while using spreadsheets or other data processing software. Skilled in identifying and recommending problem resolution. Demonstrates experience in quality assurance and performance improvement activities. Reviews electronic medical records for data collection, investigation purposes, and medical records documentation quality checks. Identifies opportunities for quality improvement initiatives. Assists the Quality Assurance Supervisor and the Quality Assurance Manager in developing and tracking plans of action for improvement processes. Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops. Stays up to date with the most updated Federal, State, and PACE regulations. Assists with the annual review of Policies & Procedures as assigned. Assists in putting together electronic files and documents for CMS quarterly calls and for CMS/State audits. Assists in putting together meeting materials, reports, and presentations as assigned. Assists in drafting and mailing letters related to notice of action (NOA), grievances, and appeals as assigned. Maintains knowledge of policies and procedures and completes tasks in accordance with applicable regulatory requirements, external laws, and accreditation standards as they relate to PACE and Quality Assurance. Attends meetings as required and participates in committees as directed. Maintains and supports a culture of compliance ethics and integrity. Additional Duties and Responsibilities: Performs other related duties as assigned or requested. Job Requirements: Experience Required: Minimum two years’ experience in healthcare, preferably in Quality Improvement; familiarity with quality improvement processes. Minimum of two years of demonstrated experience in an analytical capacity, which includes the collection, organization, and reporting of data. At least 1 year experience working with the frail or elderly population. Experience in chart review, medical documentation, coding, or strong clinical background. Education Required: Associate’s Degree or higher in a health-related field (Medical Assistant, Health Information Specialist); in lieu of an associate degree, 2 years of relevant experience and a High School Diploma is acceptable. Bachelor’s degree in quality assurance, business administration, or relevant field preferred. Certifications Required: CA driver’s license with appropriate automobile insurance required. Verbal and Written Skills Required to Perform the Job: Excellent written and verbal communication skills with specific ability to maintain accurate records. Must have active listening ability and knowledge of adult learning modes required to train, facilitate, and motivate various staff in quality improvement activities. Bilingual (English/Spanish) is preferred but not required. Technical Knowledge and Skills Required to Perform the Job: Proficient in Microsoft Office Suite (Word, PowerPoint, Excel, Outlook, Visio) to present data in easily understood formats. Advanced computer skills to learn specific applications. Meet a standardized set of competencies for the specific position description established by SYHC PACE and approved by CMS. Must have experience with EPIC. Equipment Used: Networked personal desktop, laptop computer, document center, fax, copier/scanner, and telephone. Working Conditions and Physical Requirements: Physical clearance for reaching, bending, stooping, crouching, kneeling, and grasping; have full range of motion; ability to lift 50 lbs; ability to lift and transfer participants; prolonged periods of sitting and standing. Universal Requirements: Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment. About Us: San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible, and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws. #J-18808-Ljbffr