(RN) Pace Quality and Compliance Director

The Quality and Compliance Director is responsible for directing, evaluating, and improving the quality of healthcare solutions provided to PACE participants and monitoring regulatory compliance.

PRIMARY FUNCTIONS:

·        Data Collection and interpretation to identify trends, develop education, and implementation.

·        Developing and implementing PACE quality projects, training, education, and compliance activities

·        Understand the evolving healthcare regulatory and policy environment and identify and assess the impacts on

PACE.

·        Provide leadership in identifying trends and emerging PACE compliance issues

·        Develop routine communication and collaboration with the National PACE Association

(NPA) and other Quality Leaders within the PACE network.

·        Manage Quality team to include Policy and Regulatory Manager and Quality Associate

·        Oversee Part-D regulatory compliance as well as Medicare Fraud, Waste, and Abuse

·        Completion of Level II reporting as needed and Quality reporting for CMS quarterly reporting.

·        Integral part of the CMS/SAA Audit of the PACE program

SUPERVISORY RESPONSIBILITIES

Supervise the Quality team on assigned projects as well as PBP teams to ensure that all are compliant for QAPI purposes as well as for State/Federal regulatory requirements.

SKILLS AND QUALIFICATIONS

· Registered Nurse, with 3 years of quality/process improvement experience; Master’s degree strongly preferred; and/or Master’s level in Public Administration or Health Administration

· Knowledge of the laws, standards, and regulations that apply to PACE, Medicare, Medicaid, managed care, and long-term care

·        Excellent written, verbal, and analytical skills

·        Able to work professionally with sensitive, proprietary data and information, while maintaining confidentiality.

·        Strong interpersonal skills and ability to work in a team-focused environment.

·        Demonstrated ability to work in an association membership organization is desirable.

·        Must be able to manage multiple tasks/projects simultaneously. Ability to adapt to frequent priority change

·        Previous experience in the healthcare regulatory environment

Due to data analysis, technical writing, and document control, the Quality and Compliance Director needs to have excellent computer skills and risk assessment skills. They should know Excel, Word, and other supporting quality software.

Needs to be detail-oriented and organized. Able to learn new skills quickly, manage their time effectively, and spend a lot of time communicating with other staff members

Core skills:

·        Risk Assessment

·        Data Collection

·        Operational knowledge of Excel {Spreadsheet development}

·        Interpreting data

·        Developing training

·        Experience in PowerPoint, Excel, Word, Outlook

LANGUAGE SKILLS

Ability to read, write, and understand English. Ability to read and follow written and oral directions.

Ability to read, analyze, and interpret common scientific and technical journals, regulatory guidelines, pharmacological reports, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to develop training and education to provide PACE teams. Ability to effectively present information to top management, public groups, and/or boards of directors.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to deal with problems involving several concrete variables in standardized situations.