Quality Assurance Director
- Supervised by: Executive Director, Medical Director
- Supervises: Medical Records, Contract and Credentialing Coordinator
Job Summary:
Develops, organizes and monitors a Quality Assessment and Performance Improvement Plan (QAPI) for [PROGRAM NAME]. The Quality Assurance Director, in conjunction with the Medical Director, is responsible for developing the QAPI annual plan, and guiding the implementation of the plan. This position is responsible for collecting data from all sources; tracking, analyzing and trending the data; and creating reports to be shared with all stakeholders. The Quality Assurance Director oversees the process to evaluate and resolve medical and non-medical grievances by participants, their family members, or representatives; acts as the PACE Compliance and (HIPAA) Privacy Officer; and is responsible for over sight of the Contract and Credentialing Coordinator.
Qualifications and Requirements:
Education/Training/Certifications:
- Minimum of Bachelor’s Degree in a health related field or five (5) years of relevant experience in health related field.
- Current driver’s license, proof of auto insurance and means of transportation.
Experience:
Minimum of 1 year working with a frail or elderly population.
Skills and Knowledge:
- Knowledge of quality management techniques and methods that measure and improve services and service delivery.
- Knowledge of compliance and privacy laws and regulations related to health care systems.
- Ability to coordinate and effectively lead groups.
- Ability to work in an interdisciplinary team and multi-ethnic community.
- Ability as an educator, willing to share information and serve as a mentor to other staff.
- Ability to bridge the communication and technical gap with diverse individuals
- Self-starter with strong organizational, detail oriented and with good time management skills.
- Strong analytical skills
- Able to plan and problem solve
- Computer literate (MS Word, Excel, Access, Outlook)
- Excellent written and oral communication skills.
- Strong leadership abilities.
Medical Clearance:
Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
Physical Demands and Working Conditions:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. In compliance with ADA requirements, reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Work Environment:
Employee must be able to work effectively within an interdisciplinary team model, interfacing and collaborating with a wide range of clinical and social services disciplines who work together to manage the PACE participants’ care. The work setting is in an Adult Day Health Center and primary care clinic environment with moderate noise levels and controlled temperatures.
Physical Requirements:
Requires manual and finger dexterity and eye-hand coordination; the ability to use department equipment; and the ability to lift/carry up to 30 pounds using appropriate body mechanics with reasonable accommodation if needed.
Visual, Hearing and Communication Requirements:
Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Ability to communicate by way of the telephone with participants, customers, vendors and staff.
Pressure Factor:
Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled deadlines. Potential for exposure to verbal aggression by client, vendors, and staff.
Environmental Conditions:
May be exposed to a risk of bodily injury through contact with moving instrumentation, toxic substances, medicinal preparations, bodily fluids, communicable diseases and any other conditions common in a healthcare environment. Subject to unpleasant odors.
Duties and Responsibilities:
In collaboration with the Medical Director, develops and guides the implementation of the annual QAPI Plan.
Communicate the QAPI plan to participants, staff, contractors, administration, participant advisory committee and the Board and submit the annual QAPI Plan to appropriate state and federal agencies.
Ensure staff, direct hire and contracted, integration into the QAPI process through Continuous Quality Improvement education and developing opportunities for input.
Analyze risk management data and quality assessment performance improvement activities data with the objective of identifying and controlling loss to protect the assets of the organization.
Assure that all medical records documentation requirements are met and that records and data of all types are maintained per policies and procedures and are retained for the state and federal mandated period.
Compile the necessary data and write the Annual QAPI Report at the end of the fiscal (calendar) year, review it with the Medical Director and Executive Director, and submit to the Board for approval. Once approved, share it with participants, staff, contractors, administration, and the participant advisory council. Send the annual QAPI Report to appropriate state and federal agencies as required.
Develop, monitor, and report on PACE Health Plan Management System (HPMS) quality indicators. Prepare presentation of quality improvement for quarterly Quality meetings.
Oversee the process to evaluate and resolve medical and non-medical grievances by participants and or their representatives and ensure information is reviewed for incorporation in the development of Quality Improvement initiatives and annual QAPI plan.
Attend quarterly participant advisory committee meetings and staff meetings to report on QAPI activities.
Integrate and present QAPI into orientation and training for new staff.
Facilitate QAPI meetings to ensure that the developed plan is successfully implemented, monitored and maintained.
Assist senior staff and mid-level managers with establishing process evaluation and performance improvement initiatives using PDCA (Plan, Do, Study, Act) in their area of responsibility. Help staff identify problems and facilitate problem resolution efforts.
Act as the PACE Compliance and Privacy (HIPAA) Officer and provide initial training to new hires, and ongoing training to existing staff and contract organizations on all related subject matter.
Overall responsibility for the Medicare Part D Fraud, Waste and Abuse Compliance Program. Shall report directly to the Board of Directors on matters related to FWA compliance
Develop compliance policies and procedures
Responds to reports of potential instances of FWA in [PROGRAM NAME] Prescription Drug Plan, including coordinating investigations and developing an action plan.
Reports instances of fraud to appropriate NBI MEDIC and or CMs when [PROGRAM NAME] determines that such a report is appropriate
Maintain appropriate documentation regarding [PROGRAM NAME]s FWA program
Ensure that HHS, OIG, and GSA exclusions lists have been checked monthly with respect to all employees, governing body member.
Train managers and supervisors in essential monitoring methods and measurement techniques specific to quality indicators.
Develop, implement, and analyze quality studies and quality surveys.
Coordinate internal audits and corrective action plans in collaboration with administrative staff.
Stay abreast of new developments (e.g. HPMS, other), report to Executive Director and recommend changes in policies, procedures, forms, etc. as appropriate.
Develop and implement a program of staff development and in-service training to meet regulatory requirements and organizational needs within available resources.
Maintain documentation of staff development and in- service training in compliance with standards and regulatory requirements.
Oversee compliance with all applicable regulatory, contractual standards.
Develop schedules for required periodic compliance activities, monitor implementation, analyze and report on adherence.
Recommend corrective action plans to Executive Director, and oversee and collaborate with Executive Management team activities to implement approved corrective action plans.
Manage preparations for site visits and inspections.
Manage ad hoc and special projects assigned by Executive Director.
Participate as a fully contributing member of the PACE management team, participating in meetings, contributing to strategic plan, supporting the decisions of the management team.
Participate in formulation and maintenance of PACE policies and procedures.
Perform other related duties as required.