Director of Quality and Compliance

Job Summary

Under the general direction of the CEO, the Director of Quality, Compliance and Health Informatics develops, implements, and monitors the organization’s Quality Improvement (QI) and Information Technology programs. The position also assumes responsibility for monitoring the agency’s compliance with Fraud, Waste and Abuse (FWA) program, Corporate Compliance and Privacy programs. This position also serves as the Privacy Official which is responsible for the development, implementation and ongoing administration of the organization’s policies and procedures for maintaining the privacy of personal health information as required by federal and state laws. This position must maintain current knowledge of applicable federal and state laws and applicable regulations and is responsible for facilitating cooperation with federal and state agencies when conducting an investigation or compliance review of PACE program’s policies, procedures and practices.

Specifications:

Education and Special Training: Undergraduate degree

Preferred Licensure, Registry or Certification:

• AAPC Certified Professional Compliance Officer
• Health Care Compliance Association

Experience: Minimum of (2) years of demonstrated experience in quality & compliance activities in a health-care related work environment, as well as with regulatory authorities.

Essential Job Functions:

Quality

• Organizes the agency’s quality improvement program.
• Coordinates the annual quality plan development, implementation, updates, and monitoring.
• Prepares routine and special reports, and coordinates improvement efforts arising from monitoring activities.
• Provides logical, scientific rules and methods to solve problems.
• Provides creative internal and external customer education and training on quality improvement activities and techniques.
• Manages data for quality assurance activities including collection, entry, and analysis of data including Health Plan Management System, PDSA projects, suggestion box, and surveys.
• Organizes Participant Advisory meetings and records minutes of the meeting.
• Prepares and or assists with the creation and monitoring of work plans related to QAPI.
• Ensures yearly satisfaction surveys are implemented, analyzed, monitored and reported.
• In collaboration with the CEO, conducts an annual evaluation of program and services.
• Organizes and facilitates Quality Committee meetings and other committees assigned.
• Represents the agency in external quality management initiatives such as DataPACE2.
• Assists in interface between consumers and program management for quality-related complaints.
• Interprets and implements the Centers for Medicare and Medicaid Services quality regulations to ensure compliance.
• Seeks opportunities to include national and statewide practice standards.

Informatics:

• Supervises the Health Information Technology Specialist and/or other appointed Systems Administrators
• Organizes and administers the organization’s information technology program
• Manages information technology projects for the organization
• Serves as back-up for systems administration

Compliance

• Works closely with members of the leadership team to assure compliance with all local, state and federal regulations.
• Assists with survey preparation
• Oversees and implements all aspects of the Compliance and FWA Programs including facilitation of Compliance/Privacy/FWA committee.
• Conducts annual risk assessments.
• Updates Agency Work Plans yearly.
• Provides written quarterly reports to the CEO on the operation of the Compliance, FWA and Privacy programs.
• Assists in conducting initial and periodic information audits to monitor compliance with FWA and Privacy policies and procedures.
• Develops and maintains the forms and notices necessary to effectuate PACE Program’s FWA and Privacy policies and procedures.
• Ensures that all employees, volunteers, independent contractors, Business Associates and other appropriate third parties receive the necessary Standard of Conduct, FWA and Privacy training.
• Reviews and revises all agreements with Business Associates to ensure compliance with PACE Program’s privacy policies and procedures and obtain satisfactory assurances that Business Associates will appropriately safeguard PHI.
• Ensures all participants related contracts are compliant with regulations.
• Reviews all contracts yearly to ensure compliance with agency standards and regulations.
• Relies on experience and judgment to plan and accomplish goals.
• Uses a wide degree of creativity and latitude.
• Other duties as assigned.

Demonstrates knowledge of and supports PACE mission, vision, values, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.