Quality Improvement Manager

About the role

Under the direction of the Medical Director and leadership team, the QI Manager oversees the Quality Improvement (QI) Program. Oversight responsibilities include annual review update and communication of the Quality Improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, program staff education and training around quality improvement, preparation of quality reports, and coordination of program-wide process improvement efforts arising from monitoring activities. This role ensures adherence to Centers for Medicare & Medicaid Services (CMS) and California Department of Health Care Services (DHCS) regulations while driving data-informed quality improvement efforts across interdisciplinary teams. This position works closely with clinical leadership, the Interdisciplinary Team (IDT), and the operations team to promote regulatory readiness, participant safety, and high-quality, participant-centered care.

Responsibilities

• Support and operationalize the PACE compliance program in alignment with CMS PACE regulations (42 CFR Part 460)
• Maintain up-to-date CMS and ODA regulatory knowledge and educate PACE staff appropriately
• Ensure compliance with CMS PACE and State PACE quality data, monitoring, and reporting, including quarterly reporting on PACE Health Plan Management System (HPMS) quality indicators
• Conduct internal audits (clinical documentation, service delivery, grievances, incident reporting)
• Prepare for and support external audits and site visits (e.g., CMS/DHCS audits from engagement letter to CAP acceptance)
• Monitor and ensure compliance with federal and state requirements (CMS, DHCS, Medi-Cal)
• Track, investigate, and report compliance concerns, incidents, and corrective actions
• Maintain policies and procedures to ensure regulatory alignment
• Work closely with medical records staff to conduct medical record chart reviews to monitor the quality of services provided to PACE participants and to ensure all medical records documentation requirements are compliant with federal and state regulations and that medical records are retained for 10 years
• Collaborate with the Medical Director on developing the annual QAPI Plan
• Review, revise, and communicate the QI Plan to participants, staff, contractors, leadership, and the Governing Body
• Lead and coordinate QAPI initiatives across clinical and operational domains
• Develop and monitor key performance indicators (KPIs) such as: Hospitalizations, ED utilization, falls, pressure injuries, medication management and polypharmacy, timeliness of care (urgent vs routine visits)
• Facilitate QI meetings to ensure integration of the QI Plan into PACE program operations; develop action plans and monitoring schedules for required periodic quality activities; monitor implementation; analyze and report on adherence
• Prepare and present quality data to medical and operations leadership
• Facilitate root cause analyses (RCAs) and performance improvement projects (PIPs)
• Oversee evaluating