Director of Quality and Compliance - PACE

About the role

We truly value our employees and are committed to their success! We offer long-term employment opportunities with job stability, as well as support and encouragement for career growth and advancement. Our comprehensive benefits package includes Health, Dental, and Vision insurance, Paid Time Off, 9 Paid Holidays, a 403(b) Retirement Plan with company matching, and company-paid Life Insurance.

Responsibilities

• Manages all aspects of QAPI program and other review processes to ensure quality participant care.
• Serves as NPA representative for all quality related activities.
• Supervises the Quality and Compliance Coordinator to ensure accurate and timely submission of regulatory requirements including HPMS/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 QAPI and Compliance programs and serves as the PACE HIPAA Privacy Officer, working with the LAJH HIPAA officer.
• Serves as the BCSC PACE Compliance Officer.
• Coordinates and facilitates QAPI meetings and all PACE Committee and Sub-Committees.
• Presents detailed and complete reports at selected committees leading quality related discussions.
• Controls the Quality and Compliance Department budget.
• Understands fiscal issues and is appropriately involved in meeting budget targets.
• 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.
• Serves as the BCSC PACE Compliance Officer.
• Collaborates with the LAJH Compliance Program, designs, organizes and implements the PACE Compliance Program.
• Makes sure compliance issues, CAPs, and the Fraud, Waste, and Abuse (FWA) program are monitored and measured.
• Receives and documents reports of conflict of interest and non-compliance.
• Participates as a member of the BCSC PACE Management Team.
• Agregates and analyzes information on indicators of participant risk and the care process as part of the QAPI program and provides monthly reports to members of the Quality & Compliance Committee and other members of the management team.
• Oversees the annual QAPI 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 to improve performance.
• Oversees completion of participant and caregiver satisfaction survey.
• Develops Annual QI Plan with BCSC Medical Director.
• Coordinates quality assurance activities related to new enrollees and voluntary and involuntary disenrollment.
• 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.
• Makes sure grievance and appeal logs are up-to-date and that the grievance and appeal process is proceeding according to standards and regulations.
• Reports Level II incidents to funding agencies and leads Root Cause Analysis to prepare timely submissions to CMS.
• Educates and assists PACE BCSC physicians and staff regarding QAPI Program initiatives.
• Collections aggregate information on medical specialist care of participants that is provided for analysis by the PACE Medical Director.
• 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 LAJH Medical Staff and Contracting Departments.
• Assures contracted Provider orientation.
• Oversees maintenance of vendor and provider database in a timely fashion.
• Conducts audit of all contracts to assure completion and compliance.
• Coordinates and assists to assure staff educational programs.
• Conducts audits to assure compliance with educational requests.

Requirements

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

Qualifications

Master’s degree in Nursing, Public Health, Quality Management, Health Care Management or related field. RN preferred.

Skills

• Excellent management and communication skills.
• Ability to handle complex interpersonal situations.

Benefits

Comprehensive benefits package including Health, Dental, and Vision insurance, Paid Time Off, 9 Paid Holidays, a 403(b) Retirement Plan with company matching, and company-paid Life Insurance.

Pay

N/A

Schedule

N/A

About Los Angeles Jewish Health

Los Angeles Jewish Health is dedicated to providing exceptional, comprehensive senior healthcare services, guided by our mission to deliver excellence in care for all, rooted in Jewish values. With over 100 years of trusted service to seniors, we continuously evolve to meet the unique needs of every individual we serve. As the largest single-source senior housing provider in Los Angeles, our San Fernando Valley campuses are home to over 1,000 residents. We serve more than 4,000 seniors through a range of healthcare programs, offering independent living options for those who seek the reassurance of support when needed. From adult day care to residential living, and short-term or long-term care, we tailor each senior's experience to their specific needs, ensuring personalized care at every stage of life.