PACE Quality Analyst III

San Ysidro Health Center•San Diego, CA

62d

About The Position

Under the direct supervision of the Quality Supervisor for Risk and Safety, the QAPI Analyst III is dedicated to assessing and decreasing risks associated with participant incidents as well as resolving grievances, appeals and improving participant experience through the investigation of their complaints, concerns and other feedback received. Helps develop, implement, and evaluate activities related to PACE participant satisfaction and adheres to the CMS quality reporting measures. This position may need to travel to designated San Diego PACE facility locations to assist with investigations.

Requirements

Bachelor's degree - 3 years of relevant experience can substitute for education.
3+ years of demonstrated experience in healthcare, customer service or closely related field; familiarity with the outpatient care environment and quality improvement processes; ability to handle multiple tasks in a fast-paced environment; strong organizational and planning skills; conflict resolution skills; demonstrated problem solving skills; and good judgment.
Excellent written and verbal communication skills with specific ability to maintain accurate records.
Must have active listening ability and knowledge of adult learning modes required to train, facilitate, and motivate various staff in quality improvement activities.
Proficient in Microsoft Office Suite (Word, PowerPoint, Excel, Outlook, Visio) to present data in easily understood formats.
Advanced computer skills to learn specific applications.
Meet a standardized set of competencies for the specific position description established by San Diego PACE and approved by CMS.
Tuberculosis (TB) clearance.
Must maintain current First Aid and CPR certification.
Pre-employment requirements include I-9, physical examination, positive background and reference check results, complete application, new hire orientation, and pre-employment TB clearance.

Nice To Haves

Master's degree in health-related field, business administration, human resources management or related field.
Work experience as a PACE Quality Analyst II.
Experience in dealing with medically underserved and culturally diverse populations preferred.
Customer service background or certificate.
CA valid driver's license and reliable transportation
Proof of current vehicle insurance (if applicable)

Responsibilities

Responsible for areas related to risk reduction including but not limited to participant incidents, appeals, complaints, grievances, and experiences.
Acts as a liaison between participants/designated representatives and staff to coordinate and participate in the resolution of complaints, grievances and appeals based on knowledge of the PACE Program's policies and procedures.
Promotes QAPI efforts to reduce incidents and follow through with appropriate staff for support, training, and intervention evaluation.
Acts as the primary investigator and contact person for participant grievances, appeals and incidents.
Conducts non-biased, accurate, timely, and comprehensive investigation through root-cause analysis (RCA) of all facts related to the grievance/appeal in order to submit a written response and provide feedback to involved staff.
Tracks and analyzes participant grievances and incident reports submitted by staff and stakeholders in order to identify potential participant-related risks and areas of future QAPI efforts.
Ensures there is a root cause analysis of the complaints, grievances/appeals, recommending those measures that are necessary to improve/remove causes of complaints and reduce potential risk associated with the complaints.
Investigates and conducts RCA of all incidents (medication errors included) that meet the criteria based on CMS guidelines and completes submission of these incidents in the Health Plan Management System (HPMS).
Investigates and works with the related team to ensure corrective action on all incident reports submitted.
Maintains and updates all appropriate logs/universes. Maintains and files all relevant documents.
In collaboration with departmental leaders, conducts periodic and annual trainings for staff on grievance and appeals procedures as well as incident reporting procedures.
In collaboration with departmental leaders, conducts regular trainings for service requests and other relevant trainings. Conducts detailed service request trainings for relevant new IDT members.
Participates on each CMS/DHCS call to help answer HPMS submission related questions.
In collaboration with the management team, develops a strategic plan to improve the participant experience through site visits, personal coaching and staff training to ensure service excellence delivery for staff at all levels of the PACE Program.
Provides support with respect to participant satisfaction and relations/experience initiatives including the following:
Meeting at sites that have identified areas of improvement.
Attendance at site meetings as necessary including all staff meetings and QAPI meetings.
Provides support through implementation and identification of ways to improve patient experience, streamline work processes, utilize resources more efficiently and reduce potential risk.
Proactively identifies, monitors, and summarizes participant satisfaction/complaint trends and reports to the management team on a monthly/quarterly basis.
Participates in case specific meetings when addressing incidents related to possible participant involuntary disenrollment or voluntary disenrollments due to participant being unhappy with PACE services.
Provides support in the development, design, and modification of SD PACE's policies and procedures.
Role models excellent interpersonal, mediation, conflict management, communication, and problem-solving skills
Works effectively in a team setting. Communicates effectively with participants, co-workers, and supervisors.
Demonstrates integrity, discretion and practice objective problem solving.
Maintains all records and documentation as required ensuring participant privacy and confidentiality.
Attends meetings as required and participates in committees as directed.
Maintains and supports a culture of compliance ethics and integrity.
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
Attends meetings as required and participates in committees as directed.
Performs other duties as assigned.