Director of Quality and Compliance (Pace)

Catholic Charities Archdiocese of New Orleans•New Orleans, LA

16h•Onsite

About The Position

The Quality and Compliance Manager is responsible for ensuring the PACE program adheres to all regulatory standards and exhibits excellence in quality of care. This role involves monitoring compliance with federal and state regulations, developing quality assurance policies, and coordinating efforts to improve participant services and outcomes.

Requirements

Bachelor's degree in Healthcare Administration, Business, or related field
3-5 years in quality assurance or compliance within a healthcare setting
In-depth knowledge of healthcare compliance and quality assurance.
Strong analytical and problem-solving skills.
Excellent communication and interpersonal abilities.

Nice To Haves

Master's preferred.
PACE experience is an advantage.
Relevant certification in quality or compliance (e.g., CPHQ, CHC) is desirable.

Responsibilities

Develop, implement, and oversee quality assurance systems and compliance programs, ensuring adherence to laws, regulations, and standards.
Conduct regular audits and reviews, including preparing for and leading audits by regulatory agencies.
Provide training and support to staff regarding compliance and quality improvement initiatives.
Prepare and submit quality and compliance reports as required by regulatory bodies, including HPMS/CMS reporting.
Collaborate with the leadership team, including the Medical Director and Executive Director, to foster a culture of continuous improvement, compliance, and participant centered care models.
Manage and oversee the Quality Assurance Performance Improvement (QAPI) program, ensuring quality participant care and adherence to standards.
Coordinate and monitor utilization tracking systems and quality assurance performance improvement databases and activities.
Identify workflow inefficiencies and manage the assessment and resolution processes. Oversee data management for quality improvement (QI) activities, including collection, analysis, and use of data to improve performance and policies.
Attend Board of Directors meetings and represent the organization in quality and compliance-related activities, including PACE quality improvement committees and subcommittees.
Provide oversight and direction for the development, management, and implementation of policies and procedures, including change control management.
Facilitate workgroups for the development of policies, procedures, protocols, and other job aids.
Develop tools for audit preparation, implement corrective action plans (CAPs), and ensure compliance with CMS quality measures.
Oversee the grievance and appeal process, including investigation of quality reviews and ensuring grievances/complaints are processed in accordance with regulations and standards.
Maintain and support a culture of compliance, ethics, and integrity, staying updated with relevant regulatory requirements, external laws, and accreditation standards.
Conduct annual participant satisfaction surveys and coordinate the Participant Advisory Committee.
Participate in Executive Team and Department Head meetings. Handle other projects and duties as assigned.