Quality Manager at EveryAge PACE

Quality Manager

General Summary: 

Under the supervision of the Executive Director, develops, organizes and monitors annual Performance Improvement Plan (PI) for EveryAge PACE. The Quality Manager, under the clinical guidance of the Medical Director, is responsible for developing the PI annual plan, and guiding the implementation of the plan. Ensures that data is collected from all appropriate sources; and the data is examined, and the results are shared with all stakeholders. Oversees the process to evaluate and resolve medical and non-medical service-related concerns by participants, their family members, or representatives. The Quality Manager in conjunction with Director of Quality and Compliance is responsible for all CMS and State required reporting activities. Works closely with the Director of Quality and Compliance and Chief Quality and Compliance Officer to assure EveryAge PACE follows all the local, state, and federal guidelines. 

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1. Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact. 

2. Must have a valid driver’s license, proof of insurance and have a reliable means of transportation. Must be able to meet EveryAge PACE’ auto insurance carrier's standards for coverage. 

3. Education: RN orLPNLicense – North Carolina or Minimum of Bachelor’s Degree in related field or two (2) years of relevant experience in healthcare related field strongly preferred, Cardio Pulmonary Resuscitation (CPR) and First Aid certification required. 

4. Experience:

 Familiarity with operational, financial, performance improvement, information privacy laws, policies and regulations required. 

 Minimum of 2 years working with the frail or elderly. 5. Skill(s):  Mental Skills: Reading-complex; writing-complex; repetition; clerical; analyzing; perception/comprehension; judgement; decision-making; socialization; attention to detail; communication/poise. 

Interpersonal Skills: 

Demonstrates active listening techniques; gains support through effective relationships; treats others with dignity and respect; seeks feedback. 

Leadership Skills:

Demonstrates willingness to try new tasks, generates new ideas for 2 of 8 change, evaluates and recognizes priorities; challenges others to learn; keeps current and integrates new information; communicates and models organization values; fosters high performance. 

ESSENTIAL FUNCTIONS

1. Oversees and monitors the day-to-day operations of EveryAge PACE' Quality Program. Identifies and documents all quality initiatives already in place and recommends any additional quality initiatives that should be pursued. Develops and implements a plan for monitoring the effectiveness of the Quality Program. 

2. Coordinates regular meetings of the Quality committee to ensure appropriate oversight and discussion of quality activities. 

3. Serves as Chair of the Quality Committee and works closely with management on the setting and implementation of quality initiatives, strategies, and policies. 

4. Prepares a comprehensive quality plan annually. 

5. Assists the Director of Quality and Compliance in conducting an annual quality and risk assessment based on identified risks by the Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS), and through our program’s own knowledge and experience, and based on compliance issues and concerns that have arisen in the prior year and use such risk assessment as the basis for the annual work plan/audit plan, and as guidance in developing a plan for targeted education programs. 

6. Conducts regular auditing and monitoring pursuant to the audit work plan and coordinates periodic internal compliance audits as needed. If non-compliance is detected, under the guidance of the Director of Quality and Compliance, assists affected departments or areas in developing an appropriate corrective action plan to assure resolution. 

7. Develops, and guides the implementation of the annual PI. Collaborates with the Medical Director and Executive Director in development of the annual PI plan. 

8. Reviews, revises, and communicates the PI plan to participants, staff, contractors, administration, participant advisory committee and the Board. Sends the annual PI Plan to appropriate state and federal agencies. 

9. Strives to ensure staff integration into the PI process through Performance Improvement education and developing opportunities for input. 

10. Analyzes quality management data and performance improvement data with the objective of identifying and controlling loss to protect the assets of the organization. 

11. Has overall responsibility for the Quality Program. Makes reasonable efforts to ensure completion of the activities and responsibilities identified in the Quality program and those activities and responsibilities are following state and federal regulations. 

12. Works closely with Director of Quality and Compliance and indirectly oversees functions, assuring that all health information documentation requirements are met and that records and 3 of 8 data of all types are maintained per policies and procedures and are retained for the period of 10 years. 

13. Coordinates with the Director of Quality and Compliance Director to develop/compile the Annual PI Report at the end of the fiscal (calendar) year, review it with the Medical Director and Executive Director, and share it with participants, staff, contractors, and administration, the participant advisory council and the Board. Sends the annual PI Report to appropriate state and federal agencies. 

14. Develops, monitors, and reports on PACE Health Plan Management System (HPMS) quality indicators. Prepares presentation of quality improvement for quarterly Quality Care Team. 

15. Oversees the process to evaluate, and resolve medical and non-medical grievances by participants, and or their representatives, ensures information is reviewed for incorporating issues in development of Quality improvement initiatives and annual PI plan. 

16. Assures that good faith allegations of non-compliance are investigated and responded to promptly. Collaborates with the Director of Quality and Compliance on internal investigations into suspected violations of the Standards of Conduct or organizational policies and procedures, or unethical or improper business practices. 

17. Provides quarterly, and more frequently as circumstances warrant, regular reports to the Board, the Executive Director, and other senior management on the operation and effectiveness of the QI Program. 

18. Reports information or allegations regarding violations of the law to the Director of Quality and Compliance, the Executive Director, and other senior management , as appropriate. Works with the Director of Quality and Compliance, Executive Director, and other senior management, if appropriate, in determining obligations to report violations to applicable governmental authorities and contractors. 

19. In consultation with Human Resources and the Director of Quality and Compliance, ensures that there is a mechanism in place for appropriately disciplining instances of non-compliance and maintaining consistency in application of discipline to others who engage in similar conduct. 

20. Attends quarterly participant advisory committee meetings and staff meetings and reports on PI. 

21. Integrates PI into orientation and training for new staff. 

22. Facilitates PI meetings to ensure that the developed plan is successfully installed and maintained. 

23. Assists senior staff and mid-level managers with establishing process evaluation and performance improvement initiatives using PDCA (Plan, Do, Study, Act) in their area of responsibility. Helps staff identify problems and facilitate their problem resolution efforts. 

24. Provides initial compliance and HIPAA training to new hires, and ongoing training to existing staff and contract organizations. Assists in the development and coordination of a multifaceted educational and training program with the Director of Quality and Compliance that reviews the elements of the Compliance Program and instructs all appropriate staff about pertinent federal and state standards. Assures that there is special training focused on high-risk areas identified 4 of 8 by the OIG, CMS, the annual risk assessment, and through other sources, such as audit results and reports of non-compliance. Maintains and updates, on a periodic basis, the compliance training for all staff; documents training and education activities. 

25. Trains managers and supervisors in essential monitoring methods and measurement techniques specific to quality indicators. 

26. Facilitates performance improvement communication between contract facilities and Interdisciplinary Team and associates. Participates in orientation with contract facilities to help ensure effective coordination of participants’ care. In conjunction with the Director of Quality and Compliance Director and Chief Quality and Compliance Officer, strives to ensure all business relationships and contracts are compliant with policies and procedures and state and federal regulations. Ensures that contractors are aware of the Standards of Conduct and the Compliance Program and discharge notification and training responsibilities under the Deficit Reduction Act. 

27. Develops, implements, and analyzes quality studies and quality surveys. 

28. Develops and implements internal audits and corrective action plans with required management staff. 

29. Stays abreast of new developments (e.g., HPMS, other), reports to Executive Director and recommends changes in policies, procedures, and forms, as appropriate. 

30. Updates and communicates policy revisions/updates as necessary for any changes related to training and education of all staff. 

31. Assists Director of Quality and Compliance with overseeing compliance with all applicable regulatory, contractual standards. 

32. Assists Director of Quality and Compliance with developing schedules with required periodic compliance and quality activities, monitors implementation, analyzes and reports on adherence. 

33. Recommends corrective action plans to Executive Director and oversees executive management team activities to implement approved corrective action plans. 

34. Manages preparations for local, state, and federal site visits and inspections. 

35. In conjunction with the Executive Director, conducts annual satisfaction surveys of the participants and caregivers and reports findings. 

36. Manages ad hoc and special projects assigned by Executive Director, Director of Quality and Compliance, and/or Medical Director. 

37. Participates as a fully contributing member of the management team, participating in meetings, contributing to strategic plan development, and supporting the decisions of the management team. 

38. Participates in formulation and maintenance of program policies and procedures. 

39. Coordinates with Human Resources and Administration on personnel issues to ensure that all background checks and exclusion checks have been done with respect to staff and contractors, 5 of 8 as appropriate, including checking the OIG List of Excluded Individuals/Entities, the GSA Excluded Parties Listing System, the CMS Preclusion List, and/or any state exclusion lists maintained by state Medicaid programs on an annual basis. 

40. Receives complaints concerning our organization's HIPAA and compliance policies and procedures. Maintains compliance and privacy complaint records. 

41. Assists in obtaining use and disclosure of PHI authorizations. 

42. Responsible for on-going training and education of all staff to include Service Delivery Requests and Internal/External Appeals process. 

43. Works closely with the Director of Quality and Compliance, Chief Quality and Compliance Officer and legal counsel on matters relative to compliance and risk management. 

44. Maintains safe working environment. Follows all program policies and procedures and Occupational Safety and Health Administration (OSHA) safety guidelines. 

45. Performs other related duties as required.