PACE Quality & Compliance Director

PACE QUALITY AND COMPLIANCE DIRECTOR

REPORTS TO: PACE Program Director and PACE Medical Director

POSITION REQUIREMENTS:

1. 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.
2. Prior experience in applying quality assurance principles and participating in quality assurance programs.
3. Demonstrated clinical experience in a variety of healthcare settings.
4. 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:

1. Ensures staff and contracted personnel have knowledge of Quality Improvement and share data regarding QI activities with them.
2. 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.
3. Produces data and reports on quality activities and performance and compliance.
4. 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.
5. 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.
6. Monitors AASC’s regulatory compliance and alerts PACE Director of possible deficits.
7. Schedules and conducts quarterly compliance meetings and monthly quality meetings and maintains meeting minutes.
8. Reviews and updates policies and procedures as needed.
9. Conducts annual participant satisfaction surveys.
10. Involves all staff in the QI program as owners of the program.
11. Uses standard methodology to document and assess QI activities.
12. Audits and/or maintains the Infection Control, Incident and Grievance Logs.
13. Audits the service delivery requests log.
14. Liaison with contracted vendor for the electronic medical record and trains and assists staff with usage.
15. Assists staff in process review, critical indicator selection, and threshold levels.
16. Involves PACE participants in the QI program.
17. Develops systematic reporting to all components of the PACE program system (Staff, Board of Directors, Participant Advisory Committee, and Contractors).
18. Performs chart audits to ensure completeness and accuracy.
19. Compiles and submits data to AASC, CMS, DMAS, NPA as required or requested.
20. Provides oversight of the PACE Emergency Safety Program and serves as PACE liaison to the AASC Safety Committee.
21. 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:

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