This is an opportunity to join a growing healthcare organization that has earned the Joint Commission’s Seal of Approval. As the Quality Assurance Manager, you will work under the supervision of the Health Plan Manager, to develop, organize, and monitor a Quality Assessment and Performance Improvement Plan (QAPI). The Quality Assurance Manager is responsible for developing the QAPI annual plan and guiding the implementation of the plan. Develops and guides the implementation of the annual QAPI Plan.
- Reports data and information to QA Committee, Executive Team, and Board of Directors.
- Ensures staff integration into the QAPI process through Continuous Quality Improvement education and developing opportunities for input.
- Analyses of risk management data, and Quality Assessment Performance Improvement activities data with the objective of identifying and controlling loss to protect the assets of the organization.
- Reports data and information in the manner and at the time intervals specified by CMS and the State agency.
- Facilitates the Quality Assurance Performance Improvement process for various services areas within PACE.
- Develops, and guides the implementation of the annual Infection Control Plan.
- Establish, maintain, and implement an infection control program that investigates, controls, and prevents infections in a timely manner.
- Attends the Participant Advisory Committee, assists in development of agendas, recruits and trains the meeting facilitator, and leads meeting in facilitator’s absence.
- Acts as HIPAA compliance officer provides initial training to new hires, and ongoing training to existing staff; develops and implements HIPAA policies and procedures providing direction and guidance.
- Works with the contracted credentialing liaison and Medical Director to ensure credentialing files are completed and approved.
- Assumes overall accountability of the Medical Records and Compliance departments to ensure practices are in compliance with State and CMS Agencies.
- Responsible for development, operating and monitoring the compliance plan for Medicare Part D sponsors that is comprehensive to detect, correct and prevent fraud, waste and abuse according to the requirements of the compliance plan 42CRF&423.504(b)(4)(vi).
- Responsible for training of direct patient care staff, assessment and tracking of competencies and continued evaluation.
- Performs contract facility quality assurance audits to ensure quality participant care.
- Ability to interact professionally and respectfully with geriatric individuals including those with cognitive decline and/or physical frailties
- Maintains safe working environment. Follows all Policies and Procedures and safety guidelines.
- Current unencumbered CA Registered Nurse (RN) License.
- Current BLS CPR Card certified by American Heart Association.
- Minimum three (3) years RN experience with at least two (2) years working with the frail or elderly population
- Minimum of four (4) years of demonstrated experience in quality assurance and performance improvement activities in a health related work environment