Director of Quality and Compliance

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The primary purpose of this position is to develop, implement, organize, and monitor the Quality Improvement Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance. The Director, Quality Improvement and Compliance, in collaboration with the Medical Director, is responsible for developing and implementing the annual QI plan, including leading quality initiatives and projects. In addition, the Director ensures that data is collected from appropriate sources, is examined and results are shared with all stakeholders.

Full time

Full Time, Monday-Friday, ONSITE

• Develop and implement the annual Quality Improvement (QI) Plan with the Medical Director
• In conjunction with Medical Director, initiates, develops, and guides the implementation of the annual Quality Improvement plan. Compiles annual report and shares results with leadership, staff, contractors, administration, the Participant Advisory Committee (PAC), and Board of Directors.
• Assist with scheduling and coordination of the PACE Quality Committee in collaboration with Medical Director.
• Communicate the QI plan to members, staff, contractors, administration, Participant Advisory Committee (PAC), and the Board of Directors.
• Ensure compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of Compliance plan. Ensure that colleagues complete the activities and responsibilities identified in the Compliance program and those related to the HIPAA privacy rule.
• Manage preparation for CMS site visits, audits/inspections, and all subsequent follow up activities.
• Analyze risk management data and quality data in order to identify and control loss.
• Coordinates and maintains all activities pertaining to complaints, service delivery requests, and grievances/appeals, assures regulatory compliance and incident reporting including trend analysis for necessary action plans and quality improvement initiatives.
• Plan, develop, organize, implement, evaluate, coordinate, and direct PACE program’s infection control program in accordance with current rules, regulations, and guidelines that govern such requirements.
• Prepare monthly summaries of all participant/personnel infections, corrective action taken, and the results of the corrective action.
• Lead and facilitate Participant Satisfaction and HOS‑M survey process and analyze data.
• Ensure accurate and timely reporting to CMS, State, and all other Trinity Health PACE reporting requirements.
• Daily monitoring of HPMS complaints and memorandums for quality and compliance updates. Coordinate any necessary actions per HPMS memorandum guidance.
• Prepare and submit monthly quality metrics reporting to Trinity Health PACE and participate in Trinity Health PACE initiatives, meetings, and programs as required.
• Assist staff in establishing process evaluation, including root cause analyses and performance improvement initiatives.
• Provide oversight of PACE program Quality and Compliance team members, including developing annual performance reviews.
• Oversee and/or collaborate with HIM, education, and clinical informatics team members.

• Must possess a comprehensive knowledge of healthcare delivery and management at a level as normally obtained through a bachelor’s degree (Masters Preferred) in Health Administration or other closely related field and approximately five (5) years or more of progressively more responsible related work experience that includes the development and implementation of programs for the elderly population, service operations, and staff development.
• A combination of education and experience may be acceptable.
• Minimum of one (1) year of documented experience working with a frail or elderly population preferred.
• Prior supervisory experience preferred.
• Demonstrate strong business acumen, decision‑making skills, manage conflict effectively and adapt to ongoing change.
• Maintain a customer‑focused mindset with organizational agility and work independently…