Piedmont Health Services, Inc.
  • PACE Burlington - PACE Burlington Administration
  • Full Time

QUALITY AND COMPLIANCE MANAGER

Peidmont Health Services

PACE SeniorCare

Burlington

Full-Time with Benefits

 

Job Summary:

The primary responsibility of the Quality and Compliance Manager (QM) is to develop and implement the Quality Improvement Plan for the PACE program.  This includes an annual review and update of the Quality Improvement Plan, Quality Indicators, data management, preparation of routine and special reports and coordination of improvement efforts arising from monitoring activities.  Oversees program compliance with regulations for PACE.  Conducts data analysis and champions performance improvement projects.  In the interest of quality and compliance, this position functions as a liaison between the IT department and clinical staff to optimize health information systems.

 

Minumum Qualifications:

Education/Experience: Required: Two years' experience in healthcare quality improvement and compliance, two years' progressive experience data analysis and management, and experience working in clinical informatics within healthcare or managed care setting. Strong preference for: 1); Six Sigma Lean certification, 2) RN or clinical training; and 3) Supervisory experience. One year of experience with the frail or elderly preferred.

  • Evidence of successful implementation of process improvement projects
  • Technical and analytical competency
  • Experience with EMRs and/or database planning, development, implementation, customization, and maintenance
  • Excellent interpersonal, written, and oral communication skills
  • Familiarity with the design and interpretation of data analyses
  • Demonstrates good judgment, resourcefulness, flexibility and problem solving
  • Strong time management & organizational skills, as well as attention to detail
  • Must have the ability to get along in a team environment and to motivate staff interest in quality improvement
  • Must possess the ability to learn, teach and research as well as to solve problems and think analytically/critically
  • Proven ability to mobilize teams to address quality initiatives
  • Ability to work independently and multi-task

Type of Employees Supervised: Quality Coordinator(s) and Data Specialist(s)

Licensure, Registry or Certification Required: Clinical training strongly preferred.  Bachelor's required.

Immunizations:  Be medically cleared for communicable diseases and have all immunizations up-to-date prior to beginning employment.

 

Patient Population Served:

Geriatric Adults

 

Responsiblities and Duties:

1.       Quality Improvement (50%):  

  • Conduct an annual review of the Quality Improvement Program for PHSC and update plan as appropriate with Quality staff and Quality Committee.
  • Prepare routine and special reports of Quality Improvement activities and performance.
  • Guide the Quality Committee in the development and implement program-wide Quality Indicators that are supported by evidence-based guidelines, PACE policies and reflect the clinical team's priorities.
  • Develop measures to ensure data validity, identify data's significance and report data in a meaningful format.
  • Maintains daily compliance with regulations pertaining to quality, such as appeals, grievances, requests for services, incidents, and Level IIs.
  • Conducts data analysis, focusing on population health management indicators to include cost, patient satisfaction, quality/clinical outcomes, and workforce morale.
  • Conducts PDSA, identifies opportunities for improvement, and implements performance improvement initiatives
  • Submit PHSC Quality Data to HPMS and DataPACE2.
  • Prepare PACE Quality Indicators Quarterly Summary.
  • Coordinate and attend monthly Quality Committee Meeting, subcommittee meetings, and Program management meetings
  • Assist in interface between consumers and Program Management for Quality-related complaints.
  • Assist in execution of internal/external participant appeals, as well as annual HOS-M and Participant Satisfaction Surveys.

 

2.       Compliance (20%):

  • Ensure compliance with all Federal regulations and State licensing guidelines.
  • Oversee audits and take leadership role is assimilating all requested information from Federal and State reviewers.
  • Develop and maintain all policies and procedures for PHSC to include maintenance of medical records, manuals, forms, etc. approved by the Program Management for use by the program.

3.       Health Informatics (20%)

  • In collaboration with the PHS Associate Medical Director for Health Informatics, serves as a liaison between IT and PHSC clinical staff to optimize health information systems.
  • Seek to enhance the end-user experience and advise and/or test potential hardware and software for the same.
  • Identify health-informatics training needs of end users and develop training tools.
  • Oversee report development as required for clinical, financial, quality, and regulatory reporting.
  • In collaboration with the medical director and program leadership, continuously evaluate clinical work flows and the use of EHR to promote care team integration
  • Conduct assessments of EHR usage for compliance and quality, synthesize pertinent information, and identify implications for planning and development of both clinical services and quality improvement programs.

4.       Supervision (10%):

  • Supervise staff in quality department
  • Ensure PACE Quality discipline-level initiatives are tracked routinely
  • Oversee the data specialist(s) in gathering information and accurate data management for Quality Improvement activities, including: collection, entry, analysis and assessment of data
  • Ensure Quality Indicators and utilization data is tracked
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