Position Description

PACE (Program of All-inclusive Care for the Elderly) is a Medicare program for people age 55 or older that provides community-based care and services to people certified by the state as meeting the need for nursing home level of care. The care is provided by an interdisciplinary team of professionals who work with the patient and family to develop a plan of care. The PACE model was designed to provide the following benefits to the frail elderly:
• To stay in familiar surroundings (home vs. institutional setting)
• To maintain autonomy
• To maintain a maximum level of physical, social, and cognitive function

Under the supervision of the Executive Director, the PACE QA Coordinator develops, organizes and monitors a Quality Assessment and Performance Improvement (QAPI) plan for the Neighborly Care Network PACE program. The Quality Assurance Coordinator is responsible for developing the QAPI annual plan, and guiding the implementation of the plan. Ensuring that data is collected from all appropriate sources; and the data is examined and the result are shared with all stakeholders. Oversees the process to evaluate and resolve medical and non-medical grievances by participants, their family members, or representatives. The Quality Assurance Coordinator acts as the Health Insurance Portability and Accountability Act (HIPAA) Privacy Compliance Officer for Neighborly Care Network PACE. The Quality Assurance Coordinator is responsible for over sight of the Medical Records and the Compliance Officer to ensure all Centers for Medicare and Medicaid Services (CMS) and State required activities related with these positions.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Develops, and guides the implementation of the annual QAPI plan.

2. Ensures staff integration into the QAPI process through Continuous Quality Improvement education and developing opportunities for input.

3. Analyses of risk management data, and QAPI activities data with the objective of identifying and controlling loss to protect the assets of the organization.

4. Conducts annual satisfaction surveys of the participants and caregivers of Neighborly Care Network PACE and reports findings.

5. Reports data and information in the manner and at the time intervals specified by CMS and the State agency pertaining to participant care activities and outcomes.

6. Facilitates quality assurance-related communication between contract facilities and PACE Interdisciplinary Team and employees.

7. Participates in orientation with contract facilities to ensure effective coordination of participant care, as needed provides scheduled on site inspection of contracted facilities to ensure quality care is provided and compliance with State and CMS regulations

8. Facilitates the quality assurance/performance improvement process for various services areas within Neighborly Care Network PACE.

9. Oversees the process to evaluate, and resolve medical and non-medical grievances by participants, and or their representatives, ensures information is reviewed for incorporating issues in development of Quality Improvement Initiatives and annual QAPI plan.

10. Attends the Participant Advisory Committee, assists in development of agendas, and acts as meeting facilitator.

11. Acts as Neighborly Care Network PACE HIPAA compliance officer. Provides initial training to new hires, and ongoing training to existing staff.

12. Develops and implements all policies and procedures related to HIPAA regulations.

13. Participates and offers direction across PACE departments concerning questions and all activities interfacing with HIPAA rules and requirements.

14. In conjunction with the Executive Director has overall responsibility for Neighborly Care Network PACE’s Emergency/Disaster planning, training and implementation.

15. In conjunction with the Contract and Credentialing Coordinator ensures all Neighborly Care Network PACE business relationships, and contracts are HIPAA compliant.

16. Assumes overall accountability of the Medical Records and Compliance departments to ensure practices are in compliance with State Agencies and CMS.

17. Directs, supervises and evaluates the performance of the Medical Records and Compliance personnel.

18. Ensures that the job responsibilities, authorities and accountability of all direct reports are defined and understood

19. Protects privacy and maintains confidentiality of all company procedures, results and information about employees, participants and families.

20. Practices Universal Precautions and follows all appropriate infection control procedures.

21. Participates in continuing education classes and any required staff and training meetings.

22. Performs relates duties as required or requested.

EOE/AAP Employer.

Position Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must have a valid driver’s license, proof of insurance and have means of transportation.

2. Skills and Knowledge:
• Ability to lead and supervise effectively.
• Creative, detailed-oriented and organized.
• Excellent written and verbal communication skills with specific ability to maintain accurate records.
• Ability to facilitate effective meetings.
• Excellent customer service skills.
• Must have integrity, practice discretion and practice objective problem solving.
• Data collection skills and knowledge of basic statistical principles.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, medical staff, and the public.
• Skilled in identifying and recommending problem resolution.


SUPERVISORY RESPONSIBILITIES No direct supervisory responsibilities.

EDUCATION and/or EXPERIENCE

1. Education: Minimum of Bachelors Degree in health related field or three (3) years of relevant experience in health related field.

2. Experience: Minimum of four (4) years of demonstrated experience in QAPI activities in a health related work environment.

CERTIFICATES, LICENSES, REGISTRATIONS

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Physical Requirements – Requires standing, walking, occasional pushing and pulling and lifting. Requires the ability to lift/carry up to fifty (50) pounds and push or pull objects exceeding one hundred fifty (150) pounds, using appropriate body mechanics. Requires manual and finger dexterity and eye-hand coordination. Must be able to document care provided in participants’ service records. Must be able to communicate verbally with participants their treatment plan, team members and participants caregivers.

2. Visual, Hearing and Communication Requirements - Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Must be able to communicate verbally with all staff, caregivers, participants, and community at large.

3. Pressure Factor - Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled appointments while dealing with frail and confused participants. Subject to participants that may have the potential for verbal or physical aggression.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. May be exposed to a risk through contact with toxic substances, communicable diseases and any other conditions common in a health care environment.
2. Subject to unpleasant odors.