PACE Quality and Compliance Program Manager

PacificSource Health Plans - Springfield, OR

Full-time - Mid Level

Remote - Springfield, OR

Insurance Carriers and Related Activities

About the position

The PACE Quality and Compliance Program Manager at PacificSource Health Plans is responsible for overseeing the quality improvement and compliance program for the Program of All-Inclusive Care for the Elderly (PACE). This role involves collaboration with various stakeholders to ensure regulatory compliance, develop quality improvement plans, and address quality-of-care concerns. The manager will track organizational data, implement corrective action plans, and represent the organization in regulatory audits, all while fostering a diverse and inclusive workplace.

Responsibilities

• Develop, implement, and routinely evaluate the PACE Quality Improvement plan, including QI activities and quality reporting.
• Track and analyze organizational data to identify opportunities for improvement, set measurable targets, and monitor effectiveness of change.
• Collaborate with PACE leadership to develop and implement the annual QAPI plan, including submission for review by the PACE governing body.
• Coordinate the review of input from the PacificSource PACE Quality Committee and ensure program requirements are met.
• Oversee quality reporting requirements for accuracy and timeliness of submissions to State APD and CMS.
• Represent PacificSource PACE with government agencies regarding quality and compliance, participating actively in regulatory audits.
• Educate PACE and PacificSource teams around compliance audit requirements and facilitate the development of Corrective Action Plans.
• Utilize QI models to measure and improve performance, including satisfaction and effectiveness surveys.
• Collaborate with cross-functional teams to support critical program activities and achieve performance targets.
• Monitor CMS Complaint Tracking Module (CTM) and coordinate timely responses to complaints.

Requirements

• Master's degree in a health-related field or clinical licensure as an RN, OT, or MSW preferred.
• Bachelor's degree required.
• Three years of experience focused on quality improvement, compliance, and application of state/federal regulations required.
• Three years of experience working in a healthcare setting required.
• Knowledge of PACE requirements, including care delivery model and regulatory requirements.
• Strong analytical and problem-solving skills.

Nice-to-haves

• Experience working in geriatric community-based care preferred.
• Previous PACE experience highly preferred.

Benefits

• Health insurance
• Dental insurance
• 401k plan
• Flexible scheduling options
• Paid time off
• Professional development opportunities