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Quality Assurance Lead

2 months ago

Miami, Florida, United States Community Medical Group Full time
Job Overview

Position Summary

The Quality Assurance Manager at Community Medical Group plays a pivotal role in executing the organization's Continuous Quality Improvement Program at a corporate level. This position encompasses planning, organizing, developing, coordinating, and directing quality evaluations. The manager ensures that all activities and programs within facilities comply with the relevant federal, state, and local standards, guidelines, and regulations. The primary objective is to guarantee the highest quality of care and services for residents.

Key Responsibilities

  1. Conducts root cause analyses and suggests actionable steps to enhance both clinical and non-clinical outcomes.
  2. Creates and maintains a Quality Assurance (QA) chart review checklist and oversees QA activities.
  3. Designs, implements, and manages the Corporate Compliance Program, including an internal audit process for high-risk operational, financial, and reimbursement areas.
  4. Coordinates and supervises external regulatory audit requests.
  5. Collaborates with Senior Management to develop and enhance the corporate Continuous Quality Improvement/Quality Assurance and Performance Improvement program, ensuring compliance with current regulations governing long-term care facilities.
  6. Assesses programs and provides recommendations to enhance compliance with regulatory standards.
  7. Fosters a constructive relationship as a liaison between facility management, staff, and corporate management.
  8. Develops follow-up procedures to monitor identified issues effectively.
  9. Collects and analyzes statistical quality data to pinpoint areas for improvement within the quality system.
  10. Reviews audit findings and implements necessary corrective measures.
  11. Identifies training requirements and organizes training sessions to meet quality standards.
  12. Prepares written and oral reports for facility and corporate management regarding overall operations.
  13. Acts as a liaison among various committees and departments to promote Quality Assurance/Performance Improvement in the corporation's ongoing operations.
  14. Evaluates and recommends improvements to maintain compliance with safety and infection control regulations.
  15. Contributes to billing operational standards by providing relevant information for strategic planning and reviews.
  16. Guides employee actions by developing and updating billing policies, procedures, and guidelines.
  17. Enhances job knowledge through participation in educational opportunities and professional literature.
  18. Implements educational initiatives and provides formal training on coding compliance, documentation guidelines, and Medicare/Medicaid regulations.
  19. Supports risk adjustment data validation.
  20. Facilitates provider coding education and interdepartmental coding education initiatives.
  21. Develops Policies and Procedures to uphold Best Practices within the department.