PACE Quality & Compliance Director

PACE QUALITY AND COMPLIANCE DIRECTOR

REPORTS TO: PACE Program Director and PACE Medical Director

POSITION REQUIREMENTS:

• Education equivalent to at least an Associate's Degree form an accredited college with a degree in nursing, or related field or equivalent applicable education, experience, and/or training. Prefer Bachelor's Degree in a health-related profession from an accredited institution or graduate from an accredited nursing program with experience in quality assurance.
• Prior experience in applying quality assurance principles and participating in quality assurance programs.
• Demonstrated clinical experience in a variety of healthcare settings.
• Computer experience with proficiency in excel and PowerPoint.

SUMMARY: The Quality and Compliance Director is responsible for the coordination and implementation of quality improvement activities; monitoring quality of services and care issues of Program for All-inclusive Care for the Elderly (PACE) participants; developing action plans for performance issues; communicating quality assurance activities and outcomes with staff; ensuring compliance with all federal and state regulations to maintain program excellence.

DUTIES AND RESPONSIBILITIES:

• Ensures staff and contracted personnel have knowledge of Quality Improvement and share data regarding QI activities with them.
• Develops and implements a strategic comprehensive quality assurance and risk management program based on key PACE program processes/services to facilitate an efficient and cost-effective, low risk healthcare organization.
• Produces data and reports on quality activities and performance and compliance.
• Ensures Board of Director Members are aware and have knowledge of current QI and Compliance activities; Presents QI Annual Report to the Board of Directors and conducts Compliance training with them.
• Assembles and analyzes data as information for Centers for Medicare & Medicaid Services (CMS)/National PACE Association (NPA)/Department of Medical Assistance Services (DMAS) reports as needed for the PACE Director.
• Monitors AASC's regulatory compliance and alerts PACE Director of possible deficits.
• Schedules and conducts quarterly compliance meetings and monthly quality meetings and maintains meeting minutes.
• Reviews and updates policies and procedures as needed.
• Conducts annual participant satisfaction surveys.
• Involves all staff in the QI program as owners of the program.
• Uses standard methodology to document and assess QI activities.
• Audits and/or maintains the Infection Control, Incident and Grievance Logs.
• Audits the service delivery requests log.
• Liaison with contracted vendor for the electronic medical record and trains and assists staff with usage.
• Assists staff in process review, critical indicator selection, and threshold levels.
• Involves PACE participants in the QI program.
• Develops systematic reporting to all components of the PACE program system (Staff, Board of Directors, Participant Advisory Committee, and Contractors).
• Performs chart audits to ensure completeness and accuracy.
• Compiles and submits data to AASC, CMS, DMAS, NPA as required or requested.
• Provides oversight of the PACE Emergency Safety Program and serves as PACE liaison to the AASC Safety Committee.
• Liaison to Audit Teams from CMS and DMAS, preparing documents prior to audit, assisting during audit, and responding to Audit reviews and corrective action plans.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of Quality Assurance principles and the ability to apply them to various situations.
• Ability to set objectives and develop action plans.
• Competent in identifying problems and developing effective solutions.
• Strong critical thinking skills.
• Orientation to detail and ability to see a broader picture.
• Communicate effectively orally and in writing.
• Possesses the skills to brief information to large groups.
• Proficiency in data and word processing applications.