PACE - Quality and Compliance Manager

Pace Partners Of Northeast Florida - Jacksonville, FL

Full-time - Mid Level

Jacksonville, FL

Professional, Scientific, and Technical Services

About the position

The Quality and Compliance Manager at PACE Partners of Northeast Florida is responsible for organizing and monitoring the Quality Improvement and Performance Improvement Plan (QI) for PACE Place. This role involves developing the annual QI plan, guiding its implementation, collecting and analyzing data, and creating reports for stakeholders. The manager also oversees compliance programs to ensure adherence to governmental regulations and evaluates existing policies for effectiveness, identifying areas for improvement.

Responsibilities

• Organize and monitor the Quality Improvement and Performance Improvement Plan (QI) for PACE Place.
• Develop the QI annual plan and guide its implementation.
• Collect data from various sources and analyze it for trends.
• Create reports to share with stakeholders regarding quality improvement initiatives.
• Assist in the review process for medical and non-medical grievances.
• Develop and implement an effective compliance program to meet governmental regulations.
• Review and evaluate existing company policies for effectiveness and recommend changes.
• Ensure PACE is survey ready for state and federal inspections.
• Lead survey preparation projects and act as a liaison during surveys.
• Update and manage the Biomedical Waste Plan.
• Communicate the QI plan to participants, staff, and contractors.
• Analyze risk management data and quality assessment performance improvement activities.
• Compile data and write the Annual QI Report for submission to the Board and state agencies.
• Develop, monitor, and report on quality indicators for the Health Plan Management System (HPMS).
• Prepare presentations for quarterly Quality meetings.
• Integrate QI into orientation and training for new staff.
• Facilitate QI meetings to ensure successful implementation of the QI plan.
• Assist with the development of compliance policies and procedures.
• Respond to potential instances of fraud, waste, and abuse in the Prescription Drug Plan.
• Train managers and supervisors in monitoring methods specific to quality indicators.
• Coordinate internal audits and corrective action plans with administrative staff.
• Develop and implement staff development and in-service training programs.
• Ensure compliance with all applicable regulatory and contractual standards.
• Collaborate with Human Resources regarding survey readiness and personnel records.

Requirements

• Registered Nurse (RN) with a BSN preferred and a minimum of 1 year experience.
• Health Care Quality Assurance Certification (CPHQ) or training preferred.
• Current driver's license and proof of auto insurance.
• Minimum of 1 year experience in a Quality Improvement position at a managed care company or healthcare provider.
• Experience working with a frail or elderly population, or appropriate training upon hiring.

Nice-to-haves

• Master's Level degree is helpful.
• Training and/or experience working with PACE, MA, MA-PD or PDP programs.
• Training and/or experience working with regulatory authorities.

Benefits

• Health insurance coverage
• Paid time off
• Retirement savings plan
• Professional development opportunities