PACE Quality Specialist

Chapters Health System•Fort Myers, FL

2d•$60,058 - $90,088

About The Position

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success! Education and Experience Bachelor's degree in business, healthcare administration, Nursing, Public Health, Health Information Management, Quality, Compliance, or a related field required. (Work experience may substitute for educational degree.) Minimum of 2-3 years of experience in healthcare compliance, quality, auditing, or regulatory oversight. Demonstrated experience with CMS regulations, AHCA, and PACE program requirements strongly preferred. Experience supporting or managing QAPI programs in a regulated healthcare environment preferred. Certificates, Licenses, Registrations Must possess a valid Florida Drivers' License, current auto insurance, and reliable transportation. Certification of completion of Alzheimer's Disease and Related Dementias Training through the Florida Department of Elder Affairs (or completion within six months of employment) Certified Professional in Healthcare Quality (CPHQ) preferred Lean, Six Sigma, or other quality improvement certification preferred Knowledge, Skills and Abilities Strong working knowledge of CMS, AHCA, and PACE regulations preferred Proficiency in medical terminology and clinical documentation review. Experience with healthcare auditing procedures, and performance monitoring. Strong analytical, organizational, and project management skills. Ability to interpret regulations and translate requirements into operational practices. Excellent written and verbal communication skills. Ability to work independently in a remote or hybrid environment while collaborating effectively with cross-functional teams. Proficiency in Microsoft Office suite, expertise in Excel and Microsoft Project, PowerPoint, and healthcare data systems; experience with quality reporting tools preferred. Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to define problems, collect data, establish facts, and draw valid conclusions. Strong abstract reasoning skills will be used to assess and analyze complex business workflows, processes, and systems. Ability to communicate, concentrate and document effectively and accurately. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Equipment and Machines Used Computer Printer Photo Copy Machine Telephone Fax Machine Adding Machine/Calculator All other routine office and/or company equipment. Position Requirements (not all inclusive) • Support compliance with CMS regulations, AHCA requirements, and PACE program standards, including 42 CFR Part 460. • Assist in the development, implementation, and maintenance of compliance policies, procedures, and internal controls. • Monitor regulatory updates and guidance from CMS, AHCA, and other governing bodies; communicate changes to leadership and operational teams. • Participate in regulatory surveys, audits, and site visits; assist with preparation, coordination, and response activities. • Support corrective action plans (CAPs), root cause analyses, and ongoing monitoring of compliance risks. • Projects within the PACE Program as needed at the direction of the PACE Director of Compliance and Quality. • Proven ability to lead and work through others without direct reporting relationship to achieve business goals. • Strong analytical skills balanced with communication skills the ability to understand and create understanding of complex information among a variety of stakeholders and business partners. • Demonstrated ability to manage multiple priorities and make appropriate decisions in the face of ambiguity. • Demonstrate affinity for challenging work and high responsibility and accountability. • Provide leadership, oversight, and monitoring of QAPI program for all areas of the organization. • Create connections among project teams to eliminate gaps in process design and implementation. • Identify barriers to implementation and develop and propose solutions that address both business needs and customer satisfaction. • Research, monitor and report regularly on all State, Federal and Agency regulatory changes. • Assist with development of data collection tools and process. • Monitor, track and trend data collection. Report results to management. Prepare reports appropriate for distribution at all levels of the organization. • Ensure job responsibilities are met, including attendance requirements and prompt arrival at work. Auditing & Monitoring • Conduct scheduled and ad hoc compliance and quality audits, including medical record reviews, operational audits, and regulatory compliance assessments. • Utilize auditing tools, and sampling methodologies to evaluate compliance with clinical, operational, and documentation standards. • Analyze audit findings, identify trends, and prepare clear, actionable reports for leadership and committees. • Track audit outcomes, corrective actions, and follow-up activities to ensure timely resolution and sustained compliance. Quality & QAPI Project Management • Support the organization’s Quality Assessment and Performance Improvement (QAPI) program in accordance with CMS and PACE requirements. • Assist in the planning, implementation, and monitoring of QAPI projects using recognized performance improvement methodologies (e.g., PDSA). • Collect, validate, and analyze quality metrics, key performance indicators, and outcomes data. • Prepare QAPI reports, dashboards, and presentations for Quality Committees, Compliance Committees, and leadership. • Collaborate with interdisciplinary teams to implement quality initiatives that improve participant outcomes, safety, and satisfaction. • Monitor and report outcomes of completed QAPI projects. Clinical Documentation & Medical Terminology • Demonstrate working knowledge of medical terminology, clinical workflows, and healthcare documentation standards. • Review clinical records for accuracy, completeness, and regulatory compliance. • Support documentation improvement efforts related to clinical assessments, care plans, and regulatory reporting. Education & Collaboration • Provide compliance and quality education to staff as assigned, including audit findings, regulatory requirements, and best practices. • Serve as a resource to clinical and operational teams regarding compliance and quality standards. • Participate in committees, workgroups, and performance improvement meetings as assigned. Other duties as assigned Compensation Pay Range: $60,058.27 - $90,087.92 This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy. All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit https://info.flclearinghouse.com/. Choices. Education. Guidance. As a progressive leader and premier health organization, Chapters Health System is dedicated to delivering innovative care throughout chronic illness progression and beyond. Since 1983 as a community-based, not-for-profit organization, Chapters Health has provided choices, education and guidance through its managed affiliates: Capital Caring Health, Chapters Health Foundation, Chapters Health Hospice, Chapters Health Pharmacy, Chapters Health Staffing, Cornerstone Hospice & Palliative Care, Good Shepherd Hospice, Hope Healthcare, Hospice of Okeechobee, HPH Hospice and LifePath Hospice. Chapters Health offers services throughout the Southeast and Mid-Atlantic regions of the country to improve the patient/family experience well in advance of end-of-life needs. Chapters Health and its affiliates are licensed in Alachua, Arlington, Bradford, Charlotte, Cherokee, Citrus, Cobb, Collier, Columbia, District of Columbia (all eight wards), Dixie, Fairfax, Fauquier, Fayette, Forsyth, Fulton, Gilchrist, Glades, Gwinnett, Hall, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Howard, Lafayette, Lake, Lee, Levy, Loudoun, Marion, Martin, Miami-Dade, Monroe, Montgomery, Okeechobee, Orange, Osceola, Pasco, Pinellas, Polk, Prince George’s, Prince William, Putnam, St. Lucie, Sumter, Suwannee and Union counties. Click here to view the video! All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit https://info.flclearinghouse.com/.

Requirements

Bachelor's degree in business, healthcare administration, Nursing, Public Health, Health Information Management, Quality, Compliance, or a related field required. (Work experience may substitute for educational degree.)
Minimum of 2-3 years of experience in healthcare compliance, quality, auditing, or regulatory oversight.
Must possess a valid Florida Drivers' License, current auto insurance, and reliable transportation.
Certification of completion of Alzheimer's Disease and Related Dementias Training through the Florida Department of Elder Affairs (or completion within six months of employment)
Strong working knowledge of CMS, AHCA, and PACE regulations preferred
Proficiency in medical terminology and clinical documentation review.
Experience with healthcare auditing procedures, and performance monitoring.
Strong analytical, organizational, and project management skills.
Ability to interpret regulations and translate requirements into operational practices.
Excellent written and verbal communication skills.
Ability to work independently in a remote or hybrid environment while collaborating effectively with cross-functional teams.
Proficiency in Microsoft Office suite, expertise in Excel and Microsoft Project, PowerPoint, and healthcare data systems; experience with quality reporting tools preferred.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Strong abstract reasoning skills will be used to assess and analyze complex business workflows, processes, and systems.
Ability to communicate, concentrate and document effectively and accurately.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Nice To Haves

Demonstrated experience with CMS regulations, AHCA, and PACE program requirements strongly preferred.
Experience supporting or managing QAPI programs in a regulated healthcare environment preferred.
Certified Professional in Healthcare Quality (CPHQ) preferred
Lean, Six Sigma, or other quality improvement certification preferred

Responsibilities

Support compliance with CMS regulations, AHCA requirements, and PACE program standards, including 42 CFR Part 460.
Assist in the development, implementation, and maintenance of compliance policies, procedures, and internal controls.
Monitor regulatory updates and guidance from CMS, AHCA, and other governing bodies; communicate changes to leadership and operational teams.
Participate in regulatory surveys, audits, and site visits; assist with preparation, coordination, and response activities.
Support corrective action plans (CAPs), root cause analyses, and ongoing monitoring of compliance risks.
Projects within the PACE Program as needed at the direction of the PACE Director of Compliance and Quality.
Proven ability to lead and work through others without direct reporting relationship to achieve business goals.
Strong analytical skills balanced with communication skills the ability to understand and create understanding of complex information among a variety of stakeholders and business partners.
Demonstrated ability to manage multiple priorities and make appropriate decisions in the face of ambiguity.
Demonstrate affinity for challenging work and high responsibility and accountability.
Provide leadership, oversight, and monitoring of QAPI program for all areas of the organization.
Create connections among project teams to eliminate gaps in process design and implementation.
Identify barriers to implementation and develop and propose solutions that address both business needs and customer satisfaction.
Research, monitor and report regularly on all State, Federal and Agency regulatory changes.
Assist with development of data collection tools and process.
Monitor, track and trend data collection. Report results to management. Prepare reports appropriate for distribution at all levels of the organization.
Ensure job responsibilities are met, including attendance requirements and prompt arrival at work.
Conduct scheduled and ad hoc compliance and quality audits, including medical record reviews, operational audits, and regulatory compliance assessments.
Utilize auditing tools, and sampling methodologies to evaluate compliance with clinical, operational, and documentation standards.
Analyze audit findings, identify trends, and prepare clear, actionable reports for leadership and committees.
Track audit outcomes, corrective actions, and follow-up activities to ensure timely resolution and sustained compliance.
Support the organization’s Quality Assessment and Performance Improvement (QAPI) program in accordance with CMS and PACE requirements.
Assist in the planning, implementation, and monitoring of QAPI projects using recognized performance improvement methodologies (e.g., PDSA).
Collect, validate, and analyze quality metrics, key performance indicators, and outcomes data.
Prepare QAPI reports, dashboards, and presentations for Quality Committees, Compliance Committees, and leadership.
Collaborate with interdisciplinary teams to implement quality initiatives that improve participant outcomes, safety, and satisfaction.
Monitor and report outcomes of completed QAPI projects.
Demonstrate working knowledge of medical terminology, clinical workflows, and healthcare documentation standards.
Review clinical records for accuracy, completeness, and regulatory compliance.
Support documentation improvement efforts related to clinical assessments, care plans, and regulatory reporting.
Provide compliance and quality education to staff as assigned, including audit findings, regulatory requirements, and best practices.
Serve as a resource to clinical and operational teams regarding compliance and quality standards.
Participate in committees, workgroups, and performance improvement meetings as assigned.
Other duties as assigned