Quality Improvement Director - Healthcare jobs in Wilmington, DE

Job Summary:

The PACE Director of Quality, Compliance, & Education develops, organizes and monitors a Quality Assurance and Performance Improvement Plan (QI) for PACE Your LIFE.  The Director of Quality, Compliance, & Education, in conjunction with the Medical Director, is responsible for developing the QI annual plan and guiding the implementation of the plan.  This position is responsible for collecting data from all sources; tracking, analyzing and trending the data; and creating reports to be shared with all stakeholders.  The Director of Quality, Compliance, & Education oversees the process to evaluate and resolve medical and non-medical grievances by participants, their family members, or representatives and acts as the PACE Your LIFE Compliance and HIPAA Privacy Officer.  The Director of Quality, Compliance, & Education is responsible for new hire orientation, annual staff training, and ongoing PACE education. 

Essential Duties and Responsibilities:

1. In collaboration with the Medical Director, develops and guides the implementation of the annual Quality Improvement (QI) Plan.

2. Ensures staff and contracted provider integration into the QI process through continuous Quality Improvement education and developing opportunities for input.

3. Monitors and tracks data, documentation, trends, utilization and other operational issues for potential indications of deviations in compliance, efficiency, standards of care, participant dissatisfaction, or other areas of needed improvement.  Reports this information to the QI Committee and Executive Director.

4. Provides oversight, feedback and training to support managers in improving the abilities of staff, family members, and other members of the Interdisciplinary Team working with elders and in understanding the PACE model of care and related regulations.

5. Communicates the QI Plan to participants, staff, contractors, administration, the Participant Council and the Governing Body, and submits the annual QI Plan to appropriate State and Federal agencies.

6. Compiles the necessary data and writes the Annual QI Report at the end of the year, reviews it with the Medical Director and Executive Director, and submits the report to the Governing Body for approval.  Once approved, shares it with participants, staff, contractors, administration, and the Participant Council.  Sends the Annual QI Report to appropriate State and Federal agencies, as required.

7. Develops, monitors, and reports on PACE Your LIFE for required Health Plan Management System (HPMS) quality indicators.  Prepares presentation of quality improvement for quarterly Quality meetings.

8. Oversees the process to evaluate and resolve medical and non-medical grievances by participants and/or their representatives, and ensures information is reviewed for incorporation in the development of Quality Improvement initiatives and the annual QI Plan.

9. Routinely attends Participant Council meetings and staff meetings to report on QI activities.

10. Integrates into and presents QI at orientation and training sessions for new staff and for annual review with current staff as needed.

11. Facilitates QI meetings to ensure that the developed plan is successfully implemented, documented, and maintained.

12. Assists senior staff and mid-level managers with establishing process evaluation and performance improvement initiatives using quality management processes, such as Lean/Six Sigma and PDSA, in their area of responsibility.  Helps staff identify problems and facilitates problem resolution efforts.

13. Acts as the PACE Your LIFE Compliance and Privacy (HIPAA) Officer and provides initial training to new hires and ongoing training to existing staff and contract organizations on all related subject matter.

14. In conjunction with the Executive Director and Medical Director, implements the Compliance Program.  Reports directly to the Governing Body on matters related to compliance.

15. Develops the PACE Compliance Plan and all related compliance policies and procedures according to the Medicare Part D and PACE regulations.  Ensures approval of the PACE Compliance Plan by the Executive Director, Medical Director and Governing Body.

16. Responds to reports of potential instances of FWA in the PACE Your LIFE Prescription Drug Plan, including coordinating investigations and developing an action plan.  Reports instances of fraud to the appropriate authorities if PACE Your LIFE determines that reporting criteria have been met.

17. Trains managers and supervisors in essential monitoring methods and measurement techniques specific to quality indicators, QI data, medical record auditing, and other QI performance improvement activities.

18. Monitors and evaluates compliance with all applicable regulatory and contractual standards.  Develops schedules for required periodic compliance activities, monitors implementation, analyzes, and reports on adherence.  Recommends corrective action plans to Executive Director and collaborates with and supports the Management team activities to implement approved corrective action plans.

19. Participates in and supports management in preparations for site visits and inspections by State and Federal surveyors.

20. Manages ad hoc and special projects assigned by the Executive Director.

21. Participates as a fully contributing member of the PACE Your LIFE Leadership Team, participating in meetings, contributing to the strategic plan, and supporting the decisions of the management team.

22. Primarily responsible for formulation and review of PACE Your LIFE policies and procedures.

23. Develops, implements, and analyzes quality studies and quality surveys, including participant and caregiver satisfaction surveys.

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

25. Develops and coordinates a program of staff development and in-service training to meet regulatory requirements and organizational needs within available resources.

26. Oversees and maintains documentation of staff development and in-service training in compliance with standards and regulatory requirements.

27. Maintains current skills and knowledge through continuing education.  Applies information to job responsibilities.

28. Performs administrative and related duties, as required.

Qualifications:

1. Education:

a. Minimum of Bachelor’s degree in a health-related field or five years of relevant experience in a health-related field

2. Credentials/Licensure:

a. Lean/Six Sigma training or certificate preferred

b. Current driver’s license, proof of auto insurance and means of transportation required

3. Experience:

a. Minimum of one-year experience working in a quality management role, including active use of quality management tools (PDSA, Lean/Six Sigma, etc.)

b. Minimum of one year working with a frail or elderly population preferred

c. Proficiency with Electronic Health Records, Microsoft Word, Excel, Outlook, and PowerPoint required

d. Combination of education and work experience to meet requirements

4. Age of Patients Rendered Care:

a. Adult and geriatric patients

*** Freedom from illegal use of drugs, and freedom from use and effects of use of drugs    and alcohol in the workplace.

*** Persons who have been found guilty by a court of law of abusing, neglecting or mistreating individuals in a healthcare-related setting are ineligible for employment in this position.

Knowledge and Skills:

1. General quality management practices

2. Excellent written and oral communication skills

3. Proficient with Microsoft Office Suite

4. Experience with electronic health records

5. State and/or Federal survey and regulatory compliance experience

6. Statistical analysis

7. Detail-oriented

8. Strong leadership abilities

9. Policy management