PACE - Quality and Compliance Manager

Alivia Care - Jacksonville, FL

Full-time - Mid Level

Jacksonville, FL

About the position

The Quality and Compliance Manager at PACE is responsible for organizing and monitoring the Quality Improvement and Performance Improvement Plan. This role involves developing the annual QI plan, guiding its implementation, and ensuring compliance with governmental regulations. The manager will collect and analyze data, create reports, and assist in resolving grievances while maintaining effective compliance programs.

Responsibilities

• Organize and monitor a Quality Improvement and Performance Improvement Plan (QI) for PACE Place.
• Develop the QI annual plan and guide its implementation.
• Collect data from all sources; track, analyze, and trend the data; create reports for stakeholders.
• Assist in the review process to evaluate and resolve medical and non-medical grievances.
• Develop, implement, and manage an effective compliance program to meet governmental regulations.
• Review and evaluate existing company policies/processes for effectiveness and recommend changes.
• Ensure PACE is fully survey ready for inspections and lead survey preparation projects.
• Update and manage the Biomedical Waste Plan.
• Communicate the QI plan to participants, staff, and relevant committees.
• Analyze risk management data and quality assessment performance improvement activities data.
• Compile data and write the Annual QI Report, submitting it to the Board for approval.
• Develop, monitor, and report on PACE Partners Health Plan Management System (HPMS) quality indicators.
• Prepare presentations for quarterly Quality meetings.
• Attend quarterly participant advisory committee meetings to report on QI activities.
• Integrate QI into orientation and training for new staff.
• Facilitate QI meetings to ensure successful implementation of the QI plan.
• Assist senior staff with establishing process evaluation and performance improvement initiatives.
• Help staff identify problems and facilitate problem resolution efforts.
• Assist with the development of compliance policies and procedures.
• Respond to reports of potential instances of fraud, waste, and abuse (FWA).
• Ensure compliance with all applicable regulatory and contractual standards.
• Develop and implement training programs regarding the Compliance Program.
• Maintain effective communication regarding compliance issues and policies.

Requirements

• Registered Nurse (RN) with a minimum of 1 year experience; BSN preferred.
• Health Care Quality Assurance Certification (CPHQ) or training preferred.
• Current driver's license, proof of auto insurance, and reliable transportation.
• Minimum of 1 year in a Quality Improvement or similar position at a managed care company or healthcare provider.
• Experience working with a frail or elderly population, or appropriate training upon hiring.
• Training and/or experience working with PACE, MA, MA-PD or PDP programs preferred.
• Knowledge of quality management techniques and methods.
• Knowledge of compliance and privacy laws related to healthcare systems.
• Strong analytical skills and ability to plan and problem solve.

Nice-to-haves

• Master's Level degree is helpful.
• RN/LNHA/compliance certification preferred.
• Experience working with regulatory authorities.

Benefits

• Health insurance coverage
• Paid holidays
• Professional development opportunities
• Flexible scheduling