PACE Quality and Compliance Program Manager

• 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.