Manager, Quality and Compliance - St. Paul's Senior Services

l. Job Summary:

In collaboration with the Quality and Compliance Director and Medical Director, the Quality and Compliance Manager plans, organizes, and manages the department staff and the work processes of the organizations’ Quality Assurance and Performance Improvement (QAPI) program and Compliance program. Coordinates auditing and monitoring, data collection and analysis to assure the program is efficient, effective, and data-driven and is in compliance with established standards of care and State and Federal regulations.

II. Duties and Responsibilities:

• Responsible for the efficient and effective coordination and implementation of the QAPI plan and related QAPI activities/initiatives
  • Coordinates with the interdisciplinary team to assure implementation and follow-up of QAPI projects and work group activities.
• Chairs the Quality Improvement Committees in conjunction with the Quality and Compliance Director and Medical Director and serves as a member to al QI subcommittee and workgroups.
• Oversees the collection, monitoring and reporting of all QAPI, service delivery, grievance and appeal, and utilization data. Maintains systems to show data trends.
• Drive development of clinical and non-clinical performance indicators,
  including utilization review and subcontractor and participant satisfaction
  performance indicators and provides recommendations and corrective actions related to identified trends.
• Oversees the participant/caregiver satisfaction survey process including
  coordinating administration, reviewing and analyzing results, and developing QAPI plans based on outcomes.
• Actively participates in Utilization Review and IDT to identify patterns,
  monitor use of services, ensure fair and consistent decision making, and
  preserve resources to improve care and outcomes of the care provided by
  the PO.
• Proactively educates leadership and associates regarding regulatory issues, new statutes/guidelines and safety/compliance/QI activities.
• In collaboration with the Quality and Compliance Director oversees all required quality reporting to CMS (including via the Health Plan Management System - HPMS), the State Administering Agency (SAA), the board of directors (Board), the Participant Advisory Committee (PAC), associates, participants, providers, and other federal and state agencies to maintain compliance with regulatory standards.
• In conjunction with the Medical Director and Quality department staff (as applicable) facilitates Infection Prevention Initiatives.
• May perform other duties as assigned or requested

lIl. Qualifications and Requirements:

Education: Bachelors degree in health-related field or four years of Quality and Compliance experience in a health-related field preferred.

Experience: Two to five years of demonstrated experience in quality assurance/process improvement activities/compliance activities and have knowledge of Lean processes in a health-related field.

Skills and Knowledge:

• Thorough knowledge of state and federal regulations on Primary Care Clinics, Adult Day Centers, Home Health, HIPAA, and PACE.
• Working knowledge of physical, mental and social needs of the frail elderly population
• Knowledge of auditing, monitoring, data collection and analysis methods
• Ability to collect, interpret and analyze data
• Knowledge of developing and implementing staff education
• Must demonstrate the ability to communicate clearly and concisely in oral and written form.
• Competencies needed for this position include strong interpersonal relationship skills, detail oriented, work in collaboration with others, demonstrate a high degree of integrity and personal commitment, possess strong analytical skills, be able to work independently and manage multiple deliverables at the same time.
• Ability to function in a matrix environment and demonstrate a passion to succeed, be self- motivated, dependable, committed, and a willingness to see a project through to its conclusion.
• Works effectively in multi-disciplinary teams, leading and facilitating, to move the organization to new areas of excellence.

lV. Physical Demands and Working Conditions:

• Visual, Hearing and Communication Requirements - Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Must be able to communicate verbally with all staff, vendors, and clients.
• 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 lbs. using appropriate body mechanics.
• Pressure Factor - Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled appointments. Subject to people that may have the potential for verbal or physical aggression.
• Environmental Conditions - May be exposed to a risk through contact with toxic substances, communicable diseases and any other conditions common in a health care environment. Subject to unpleasant odors.

Reports to: Quality and Compliance Director