PACE Quality Coordinator

United Health Centers of the San Joaquin Valley•Fresno-Corporate, CA

About The Position

The PACE Quality Coordinator supports the implementation, monitoring, and evaluation of the Program of All-Inclusive Care for the Elderly (PACE) Quality Improvement and Compliance Program. The role works collaboratively with the interdisciplinary team (IDT), leadership, and operational departments to support compliance with Centers for Medicare & Medicaid Services (CMS), California Department of Health Care Services (DHCS), and PACE regulatory requirements. It supports participant compliance initiatives, quality improvement activities, incident management, grievance and appeal oversight, quality reporting, audit readiness, performance improvement projects, and regulatory compliance, while promoting continuous improvement and participant-centered care. The coordinator supports the Quality Improvement Program by monitoring standards and procedures, collecting and analyzing performance data, contributing to annual evaluations and work plans, and assisting with improvement projects using Plan-Do-Study-Act (PDSA) methodology. The role also serves as the operational lead for the PACE Safety Program, coordinating safety committee activities and working with PACE leadership, the IDT, transportation, facilities, and risk management to promote participant safety and regulatory compliance. Safety responsibilities include maintaining a monthly safety dashboard; monitoring and reporting safety and transportation indicators; coordinating root cause analyses (RCA) and corrective actions; conducting or coordinating safety rounds and audits; supporting emergency preparedness; monitoring staff and contractor safety education; and maintaining safety and regulatory records. The coordinator also monitors and investigates incidents, unusual occurrences, and participant safety events, and supports the resolution of identified quality concerns. The position coordinates grievance and appeal tracking and reporting; supports regulatory reporting, audits, surveys, and corrective action plans; conducts medical record audits and quality reviews; monitors performance indicators; assists with utilization review and infection prevention surveillance; and supports committees through reports, presentations, documentation, and follow-up. It provides quality improvement education and collaborates with staff to identify opportunities for improvement.

Requirements

Three years of relevant experience, including conducting and managing a continuous quality improvement project in a healthcare environment, safety, and relevant managed care and clinical experience.
Ability to gather information from multiple sources, understand context, analyze information, draw conclusions, and make recommendations.
Experience conducting Root Cause Analyses (RCA), Failure Mode and Effects Analysis (FMEA), quality audits, and performance improvement initiatives.
Advanced Word, Excel, and PowerPoint experience; excellent computer skills and ability to learn new software quickly.
Experience developing dashboards, quality reports, and executive-level presentations.
Ability to interpret regulatory requirements and translate them into operational workflows and quality improvement initiatives.
Descriptive statistics skills and comprehensive understanding of appropriate applications of interpretive statistics.
Analytical reasoning skills, including interpreting and evaluating complex information and identifying patterns and essential issues.
Ability to quickly build and maintain rapport with patients and providers from differing backgrounds; team-player and customer-service orientation.
Knowledge of basic continuous improvement tools, work process redesign, or re-engineering.
Ability to handle multiple tasks simultaneously.
Familiarity with learning and development concepts, adult learning, and general training techniques.
Strong problem-solving skills, sound judgment, effective leadership skills, attention to detail, and excellent follow-through.
Flexibility, dependability, and positive professional insight.
High degree of comfort, experience, and credibility interacting with healthcare leaders, including C-level executives and Medical Directors.

Nice To Haves

Bachelor's degree in health sciences, business, healthcare administration, health information management, or management engineering.

Responsibilities

Coordinate implementation and monitoring of the PACE Quality Improvement Program and related initiatives.
Collect, analyze, trend, and report quality performance data; support annual program evaluations and work plan development.
Assist with quality improvement projects using Plan-Do-Study-Act (PDSA) methodology.
Coordinate the PACE Safety Committee, including agendas, facilitation, minutes, action-item follow-up, and reporting to the Quality Management Committee.
Assist with implementation and monitoring of the PACE Transportation Safety and Risk Management Program.
Develop and maintain the monthly PACE Safety Dashboard and monitor participant safety and transportation quality indicators.
Coordinate root cause analyses for serious participant safety events and monitor corrective action plans.
Conduct quarterly environmental safety rounds and coordinate annual transportation safety, participant home safety, emergency preparedness, and life safety audits or inspections.
Assist with monitoring the PACE Emergency Preparedness Program, including participant accountability, emergency drills, continuity-of-care planning, and emergency communications.
Collaborate with relevant departments and the IDT to identify participant safety risks and implement corrective actions.
Monitor completion of required safety education, competency assessments, and regulatory training for PACE staff and contracted transportation providers.
Assist with development, implementation, and annual review of safety, risk management, emergency preparedness, and transportation safety policies and procedures.
Participate in CMS, DHCS, and regulatory surveys by coordinating documentation, responding to requests, and monitoring corrective actions.
Maintain safety documentation, audit reports, committee minutes, incident investigations, and regulatory records.
Monitor, investigate, and track incidents, unusual occurrences, and participant safety events; conduct root cause analyses and assist with corrective action planning.
Track and trend falls, infections, medication errors, wounds, hospitalizations, emergency department visits, and other quality indicators, ensuring timely follow-up on concerns.
Coordinate intake, tracking, investigation, and reporting of participant grievances and appeals; monitor trends and recommend improvements.
Prepare monthly and quarterly reports for leadership and committees.
Support regulatory compliance and required quality report preparation and submission; monitor deadlines and reporting accuracy.
Assist with audit preparation, responses, and corrective action plans.
Conduct medical record audits and quality reviews; monitor performance indicators and assist with utilization review and infection prevention and control surveillance.
Track corrective actions and monitor intervention effectiveness.
Prepare reports and presentations for the Quality Management Committee, Quality Improvement Committee, Leadership Team, and Board of Directors.
Record, maintain, and distribute committee documentation and follow up on action items and improvement initiatives.
Provide quality improvement education and support to staff and collaborate with interdisciplinary team members to identify improvement opportunities.