Director of Quality and Compliance - PACE
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Jul 14

Director of Quality and Compliance - PACE

Brandman Centers for Senior Care/PACE
Full time (40 hours)
Daytime, Monday - Friday
Reseda, CA

Under the direct supervision of the Brandman Centers for Senior Care (BCSC) Executive Director, and with the BCSC Medical Director, the PACE Director of Quality and Compliance (DQC) develops, implements and evaluates all activities of the Quality Improvement (QI) and Compliance Programs.

Activities relate to individuals, organizations and facilities that regulate or provide service directly or under contract with PACE.

The DQC will administer the program by implementing systems and processes designed to ensure compliance with applicable laws, regulation and standards.

DELEGATION OF AUTHORITY

As the PACE Director of Quality and Compliance, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties.

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

ADMINISTRATIVE FUNCTIONS

• Manages all aspects of QI program and other review processes to ensure quality Participant care.

• Ensures compliance with all State and Federal regulations regarding PACE services.

• Serves as National PACE Association (NPA) representative for all quality related activities.

• Supervises the Quality and Compliance Coordinator to ensure accurate and timely submission of regulatory requirements including Health Plan Management System (HPMS) and Centers for Medicare and Medicaid Services (CMS) reporting and other related duties.

• Works closely with the Medical Director, Executive Director, and Interdisciplinary team (IDT) to identify standards, develop indicators, collect and analyze data and provide corrective action to improve performance.

• Maintains confidentiality of all records, documentation, and information that pertain to the QI and Compliance programs and serves as the PACE HIPAA Privacy Officer, working with the Los Angeles Jewish Health HIPAA Officer.

• Serves as the BCSC PACE Compliance Officer.

• Coordinates and facilitates QI meetings and all PACE Committee and Sub-Committees. Presents detailed and complete reports at selected committees leading quality related discussions.

• Provides oversight and direction for development, change control management, and implementation of PACE policies and procedures. Facilitates ad hoc workgroups for the development of policies, procedures, protocols, flowcharts and other job aids.

• Organizes and serves as project lead for audits by regulatory agencies. Develops tools to aid in preparation for audits; monitors progress of audit preparation; provides onsite direction for reviewers; develops and implements corrective action plans (CAP); and ensures timely submission and communication with regulators agencies regarding the audits.

• In collaboration with the Los Angeles Jewish Home (LAJH) Compliance Program, designs, organizes and implements the PACE Compliance Program. Monitors and measures compliance issues, CAPs, and the Fraud, Waste, and Abuse (FWA) Program. Receives and documents reports of conflict of interest and non-compliance.

• Participates as a member of the BCSC PACE Management Team.

• Aggregates and analyzes information on indicators of Participant risk and the care process as part of the QI program and provides reports to members of the Quality Improvement Committee and other members of the management team.

• Oversees the annual QI Plan update and works closely with the PACE Medical Director, Executive Director, and IDT to identify standards, develop indicators, collect and analyze data and provide corrective action plans to improve performance.

• Oversees completion of Participant and caregiver satisfaction surveys.

• Development of Annual QI Work Plan with BCSC Medical Director.

• Coordinates quality improvement activities related to new enrollees and voluntary and involuntary disenrollments. Works closely with the Executive Director and Center Manager to receive, document and resolve reports of Participant rights violations, grievances, appeals and other issues related to services and quality of care. Monitors the grievance and appeal logs to ensure that they are up-to-date and that the grievance and appeal process is proceeding according to standards and regulations.

• Reports PACE Quality Monitoring and Reporting Guidance regarding incidents to regulatory agencies, as required, and oversees Root Cause Analysis to prepare timely submissions to CMS.

• Educates and assists PACE BCSC physicians and staff regarding QI Program initiatives

• Reports to the Center Manager any discrepancies in processes and systems that might present a compliance or regulatory concern, suggests process improvement remedies, and coordinates improvement team efforts.

• Supervises the development, management, and maintenance of all BCSC Provider and Vendor contracts.

• Works closely with Los Angeles Jewish Health Medical Staff and Contracting Departments

• Ensures contracted Provider orientation.

• Oversees maintenance of vendor and provider database in a timely fashion.

• Conducts audit of all contracts to ensure completion and compliance.

• Coordinates and assists to ensure staff educational programs.

• Conducts audits to ensure compliance with educational requests.

EDUCATION AND EXPERIENCE

• Degrees and Diplomas: Master’s degree in Nursing, Public Health, Quality Management, Health Care Management or related field. RN preferred.

• Certificates, Licenses: Must have a valid California driver’s license.

TB screening and successful completion of a health examination by a health care provider is required for employment.

• Experience: Minimum of two years of experience in management. Minimum of two years in the quality improvement area. Professional experience administering, collecting and analyzing data and survey results.

• Skills/Aptitudes: Excellent management and communication skills. Ability to handle complex interpersonal situations.

SPECIFIC REQUIREMENTS

• Must be able to read, write, speak, and understand the English language.

• Must possess the ability to make independent decisions when circumstances warrant such action.

• Must possess the ability to deal tactfully with personnel, Participants, visitors and the general public.

• Must be knowledgeable of medical terminology, laws, and regulations as they pertain to long term care.

• Must possess the ability to work harmoniously with other personnel.

• Must possess the ability to minimize waste of supplies, misuse of equipment, etc.

• Must be able to follow written and oral instructions.

• Be knowledgeable in computers, data input and output.

• Must be able to relate information concerning a Participant’s condition.

• Must not pose a direct threat to the health or safety of other individuals in the workplace

Is Temporary: No
Cover Letter Req.: Yes

Application

Director of Quality and Compliance - PACE

Please upload your resume or fill out the application.
Highest level of education completed.