PACE Quality and Compliance Program Manager
2 weeks ago
Join PacificSource and help our members access quality, affordable care
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Responsible for the successful coordination and management of the Program of All-Inclusive Care for the Elderly (PACE) quality improvement and compliance program. Position requires heavy collaboration with PacificSource Corporate Compliance in the coordination of the PACE compliance program. This position works closely with the PACE Executive Director, PACE Chief Medical Officer, Medical Director, Center Manager, and PacificSource Compliance Specialist(s) to ensure regulatory requirements are met and that quality-of-care concerns are addressed.
Essential Responsibilities:
- Develop, implement, and routinely evaluates PACE Quality Improvement plan, including QI activities and quality reporting.
- Track and analyze organizational data to identify opportunities for improvement, set measurable targets, and monitor effectiveness of change.
- In collaboration with PACE CMO, Medical Director and Executive Director, develop and implement annual QAPI plan, including submission of the plan for review annually by the PACE governing body.
- Coordinates the review of input from the PacificSource PACE Quality Committee.
- Ensure program requirements are met and reports findings to PACE Governing Body.
- Oversee quality reporting requirements for accuracy and timeliness of submissions to State APD and CMS.
- Collaborate with PACE leadership in planning and organization of processes associated with the QI program.
- Represent PacificSource PACE with government agencies regarding quality and compliance participating actively in regulatory audits.
- Educates PACE and PacificSource team around compliance audit requirements. Facilitates the development and implementation of Corrective Action Plans.
- Utilize QI models to measure and improve performance, including utilization of services, satisfaction and effectiveness surveys, and assessments.
- In collaboration with PACE Leadership, Director of Corporate Compliance, and Compliance Specialist, ensure compliance with all applicable regulatory standards.
- Collaborate with cross functional teams to support critical program activities and achieve performance targets.
- Coordinate responses with Grievances and Appeals. Report out on trends to the PACE Governing Body, State APD and CMS.
- Monitor CMS Complaint Tracking Module (CTM) and coordinates timely response to complaints, including corrective action planning.
- Stay apprised of current quality improvement and compliance trends in PACE through engagement with the National PACE Association Quality Committee and CMS newsletters. Implement relevant measures at PacificSource PACE.
- Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy.
- Work a manner that is consistent with PacificSource core values and State and Federal regulatory requirements.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Three years of experience focused on quality improvement, compliance, and application of state/federal regulations required. Three years of experience working in health care setting required. Experience working in geriatric community-based care preferred. Previous PACE Experience highly preferred.
Education, Certificates, Licenses: Bachelor's degree required. Master's degree in health-related field, or clinical licensure as an RN, OT, MSW, preferred.
Knowledge: Knowledge of PACE requirements, including care delivery model and regulatory requirements. Must have strong analytical and problem-solving skills. Ability to lead with high motivation and strong interpersonal/communication skills (oral and written) to accurately and effectively interpret data and communicate results to internal and external customers. Knowledge and experience using PDCA cycles and other QI models to initiate change. Knowledge and use of data management platforms, including the ability to generate reports and analyze data.
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. This position allows for hybrid, remote work.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
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