Quality Coordinator

Key Responsibilities

• Supports and assists with the creation and maintenance of the PACE Audit Universe Data Sets, which are required by CMS regulations.
• Assists the Center Managers to ensure the Senior TLC Service Determination Requests, Appeals, and Grievances (SDAG) process meets regulatory requirements.
• Advises IDT on regulatory requirements of the SDAG process.
• Oversees the completion of both internal and external third party appeals of denied service requests.
• Captures and updates the annual review of the Quality Improvement (QI) program for their Pace program, from input from the Quality Committee and Leadership Team.
• Communicates applicable policies and procedures to appropriate staff and prepares presentations for the STLC Board of Directors.
• Oversees and coordinates the development and implementation of program-wide and center-specific quality indicators.
• Plans and oversees education for STLC staff on QI activities and techniques including staff engagement activities (ex. Featured Friday program).
• Assists in performing the appropriate statistical analysis to ensure consistency and ease of presentation and review to detect trends, patterns, and opportunities for improvements as well as potential problems.
• Effectuates program specific quality program based on the annual Quality Plan and Quality Workplan.
• Schedules, coordinates, and facilitates site QI Committee meetings monthly and quarterly.
• Coordinates and participates with national and state initiatives in PACE quality management initiatives.
• Engages with the NC PACE Quality Committee.
• Oversees data management for QI activities including coordination of collection, entry, analysis and assessment of data.
• Responsible for ensuring that the statistical data collected and reported is accurate, timely, and complete.
• Completes submission of data into appropriate data submission program (i.e. HPMS, ePace, NC Benchmarking, etc.).
• Facilitates Corrective Action Plans (CAPs) as directed by the Medical Director, Compliance Department, Quality Manager, and/or Leadership Team where opportunities for improvement are identified.
• Processes include identification of global problems, development of improvement plans, and implementation of plans to then evaluate their effectiveness.
• Oversees the completion of level II root cause analysis reports and completes submission to DHB (email) and CMS (HPMS) timely.
• Creates monthly and quarterly CMS call agendas and supports account manager with facilitating the meeting.
• Coordinates and facilitates program quality projects.
• Works alongside the Quality Manager with organizational quality projects to carry out at the program level.
• Attends various committee meetings to coordinate program quality initiatives (ex. falls committee, infection control committee, wound care committee, utilization review committee).
• Updates Senior TLC quality initiatives tracking accordingly.
• Attends Participant Advisory Committee meetings to share participant rights (including grievance and appeal rights) and program quality initiatives.
• Documents Quality Improvement Projects generated by the Quality Committee for reporting to the STLC Leadership Team(s) and Board of Directors.
• Participates in priority setting with the Leadership Team, in consultation with staff and participants, and determines priorities for performance improvement.
• Assists with collecting and providing supporting documentation for external audits.
• Updates findings tracking log with internal areas of noncompliance identified and works alongside the supervisor and compliance department regarding root cause and follow-up actions.
• Immediately communicates problems that are found to threaten the immediate health and safety of participants or staff to the Senior TLC Executive Program Director and Medical Director to facilitate, along with the IDT, the development of any required corrective plans within 24 hours.
• Orients Staff and Contract Providers to Senior TLC’s Quality Program.
• Assists in interface between consumers and program management for quality related complaints.
• Ensures compliance with Federal, State, and Local laws and regulations along with the Compliance Department.