Job Description:
Industry: Healthcare / Health Services - Managed Care
Job Category: Medical / Health - Other Medical / Health
Job Duties
Under the direction of the Executive Director and in close collaboration with the Medical Director, the Director, Quality Improvement (QI) develops and implements an effective and robust PACE quality program that ensures participants are uniquely cared for. As a compliance leader and driver of care excellence, the QI Director oversees QI activities, guides the QI team, and effectively communicates quality results to participants, team members, the board and its committees, and regulatory agencies.
This position is full-time on-site that will be supporting both our Stockton & Modesto Quality teams.
Essential Job Duties:
Partner with all market QI Directors to monitor and standardize the QI program for PACE programs across the enterprise.
Collaborate with the Medical Directors and QI team members on the development and implementation of QI program initiatives, and leverage best practices among PACE programs.
Collaborate with our Chief Medical Officer and Medical Directors to develop and standardize enterprise metrics in clinical excellence, quality, and patient safety in alignment with all policies and procedures, as well as local, state, federal, and CDC guidelines.
Collaborate with Compliance team to monitor and improve compliance issues, corrective action plans, and the Fraud, Waste, and Abuse program.
Oversee the grievance and appeal process, including the delegation of investigating all quality reviews for potential quality of care concerns, as well as quality of service and access issues, including collection and evaluation of appropriate data.
Support PACE program procedures to process grievances and complaints in accordance with applicable state and federal regulations, compliance standards, and policies and procedures.
Develop and maintain relationships with state and federal regulatory agencies, including the CA Department of Health Care Services and Centers for Medicare and Medicaid Services.
Job Requirements:
Bachelor's degree required, Master's degree in relevant field preferred.
Experience as Lean Six Sigma green belt or black belt preferred.
Formal Quality Improvement and Analytics Certifications preferred.
Minimum of five (5) years of experience as a QI/Assurance Director or Manager in a healthcare setting, or managing health/eldercare programs with oversight of QI or compliance.
Two (2) years of supervisory experience with demonstrated ability to mentor and develop team members.
Candidate Details
7+ to 10 years experience
Seniority Level - Director
Management Experience Required - No
Minimum Education - Bachelor's Degree
Willingness to Travel - Occasionally
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