Vice President of Quality and Compliance

POSITION SUMMARY: The Vice President (VP) of Quality and Compliance is responsible for the leadership, oversight, and continuous improvement of Rocky Mountain PACE’s (RM PACE) Quality Improvement Program and enterprise-wide Compliance Program. This role ensures adherence to all PACE-specific state and federal requirements including CMS, HCPF, HIPAA, and other regulatory standards. Partners closely with the Interdisciplinary Team (IDT), clinical leadership, and organizational leadership to support high-quality, person-centered care for older adults.

The VP reports directly to the Chief Nursing Officer (CNO) and collaborates with the Executive Leadership Team in strategic planning, regulatory readiness, and organizational performance improvement.

MISSION: Improving lives, Optimizing wellness, Promoting independence

COMPETENCIES:

• Effective Supervision
• Balanced Decision Making
• Strategic Focus
• Manages Conflict
• Effective Communication
• Facilitates Change
• Problem Solving
• Quality Focus
• Personal Credibility
• Decisiveness

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS

Compliance Leadership

The VP of Quality and Compliance oversees and manages the RM PACE compliance program to ensure alignment with PACE regulations and all applicable federal and state requirements.

• Develops, implements, and maintains comprehensive compliance programs across RM PACE with emphasis on PACE program requirements. 
• Ensures organizational adherence to local, state, and federal regulations, including CMS PACE regulations, HCPF requirements, HIPAA, fraud/waste/abuse (FWA) standards, and internal policies.
• Maintains current knowledge of regulatory updates and communicates changes to leadership and staff.
• Oversees the development, implementation, and annual review of organizational policies and procedures to ensure regulatory compliance.
• Develops and leads the Compliance and FWA Training Program, including annual training for the Board of Directors and all employees.
• Oversees the Compliance Hotline and directs clinical investigations related to potential violations of laws, regulations, policies, or Standards of Conduct. Documents findings and corrective actions and reports outcomes to the CNO and Board of Directors as appropriate.
• Conducts compliance risk assessments, develops monitoring and auditing work plans, and completes the required CMS PACE and Part D readiness checklists.
• Recommends and oversees corrective action plans related to identified deficiencies and ensures appropriate reporting to regulatory bodies when required.
• Oversees timely completion and submission of compliance reporting to CMS, HCPF, and other entities.
• Provides regular compliance updates and an annual compliance report to the Board of Directors.

Quality Management and PACE Performance Improvement

The VP ensures a robust Quality Improvement (QI) structure that supports safe, effective, person-centered care across RM PACE.

• In collaboration with the Chief Nursing Officer, Chief Medical Officer, Executive Leadership, Quality Team, and IDT clinical leaders, develops and monitors PACE quality improvement activities.
• Establishes key quality metrics, benchmarks, and outcome measures required by CMS and State PACE regulations. 
• Oversees Quality Committees and the development, review, and implementation of Quality Plans.
• Ensures accuracy of quality and regulatory data submitted to State and Federal agencies.
• Ensures use of evidence-based QI methodologies (including PDSA cycles) to drive performance improvement.
• Oversees participant and caregiver satisfaction survey processes, reporting, and improvement planning.
• Leads PACE survey readiness for CMS and State audits or monitoring visits. Oversees Corrective Action Plans and ensures timely follow-up.
• Ensures timely completion of all licensing and certification renewals.

HIPAA Privacy Oversight

• Monitors changes in federal privacy laws and updates RM PACE’s Privacy Program accordingly.
• Ensures compliance with all regulations governing the collection, use, maintenance, and disposal of protected health information (PHI).
• Updates the organizational privacy plan and associated policies and procedures at least annually.

Strategic Leadership and Planning

The VP plays a key role in organizational strategy with specific focus on quality, compliance, and PACE program requirements.

• Collaborates with the Executive Leadership Team and CNO to develop and maintain the RM PACE Quality and Compliance strategic plan, including annual and multi-year goals.
• Develops and manages the annual Quality and Compliance Department budget, ensuring alignment with organizational priorities and regulatory requirements.
• Oversees department expenditures, monitors financial performance, and ensures responsible stewardship of resources.
• Uses strategic plans to guide decision making, resource allocation, and outcome measurement.
• Provides quarterly updates to Senior Leadership and the Board of Directors. 
• Demonstrates leadership in organizational meetings, Quality Team meetings, and interdisciplinary settings.
• Identifies innovative opportunities to enhance participant outcomes, reduce risk, and strengthen regulatory compliance.

Internal & External Partnerships

• Promotes a culture of quality, compliance, and continuous improvement across RM PACE.
• Builds collaborative relationships with business line leaders, IDT members, medical staff, and administrative departments.
• Strengthens relationships with CMS, HCPF, auditors, community partners, contractors, and vendors.
• Effectively communicates quality and compliance goals, outcomes, and expectations to internal and external stakeholders. 

• Bachelor’s Degree required, Master’s Degree preferred in healthcare administration, business administration, or related field.
• 2-5 Years’ experience of progressively responsible compliance experience, involving audits, risk management, and/or ethics and privacy programs.
• 2-5 years’ experience in healthcare, especially with the frail, elderly or other disenfranchised populations preferred.
• Must have excellent written and verbal communication skills and demonstrate the ability to interact clearly and effectively with both internal and external customers.
• Advanced skills in Microsoft Office, including Word and Excel.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, vendors, medical staff, and the public.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, vendors, medical staff, and the public.