QI and Compliance Analyst

Gary and Mary West PACE • San Marcos, CA

1d • $64,000 - $66,000 • Hybrid

About The Position

The Quality Improvement and Compliance Analyst works under the direct supervision of the Quality Improvement & Compliance Director. The analyst monitors staff compliance with state and federal regulations and GMWP policies and procedures, and partners with the leadership team to promptly resolve compliance issues. The role also supports timely processing of grievances and appeals in accordance with applicable regulatory requirements and organizational policies for each line of business. The analyst facilitates collaborative relationships across GMWP teams and stakeholders in support of the organization’s values, team culture, and mission.

Gary and Mary West PACE is a nonprofit serving frail older adults in North County San Diego through medical, social, and behavioral services. Its mission is to help seniors age in place with compassionate, comprehensive health and supportive care. This is a hybrid position.

Requirements

• Bachelor’s degree in a related field or five years of experience working in a Program of All-Inclusive Care for the Elderly (PACE).
• Experience managing data and conducting analyses with productivity-suite software, including complex spreadsheets; experience with relational or hierarchical databases is preferred.
• Knowledge of HIPAA Privacy and Security.
• Knowledge of state and federal PACE regulations and contractual requirements.
• Ability to meet deadlines and manage tasks accordingly.
• Strong analytical and organizational skills and professional verbal and written communication skills.
• Ability to work independently with minimal supervision and to multitask.
• Competence using computers for business analysis and communication.
• Ability to maintain strict confidentiality.
• Demonstrated ability to work and communicate effectively with employees at all levels.
• Proficiency with Microsoft Office Suite, including Word, Outlook, PowerPoint, and Excel.
• Ability to process information accurately and in a timely manner.
• Strong leadership, organizational, customer service, and communication skills when working with seniors, their families, and interdisciplinary team members.
• Ability to work independently, execute tasks in a quickly changing environment, and make sound decisions in emergency situations.
• Experience and competency working with people from diverse backgrounds.
• Commitment to unlocking the full potential of vulnerable seniors.
• Medical clearance for communicable diseases and up-to-date immunizations before direct participant contact.
• Successful pre-employment drug screen, background check, and physical assessment.

Nice To Haves

• Experience working in an Electronic Medical Record (EMR).
• At least one year of experience with a frail elderly population.

Responsibilities

• Collect Quality Improvement department data, including data specified in the QI plan and required by state and federal regulations.
• Conduct medical record audits and monitor participant records for complete and timely documentation.
• Maintain regulatory compliance of medical records in accordance with HIPAA standards and ensure records are retained for the minimum period required by GMWP policies and procedures.
• Participate in ongoing EMR training and learning opportunities related to system enhancements, upgrades, and workflows.
• Assist with developing EMR training materials, content, and topics based on chart reviews and input from leadership and users.
• Track and trend Service Delivery Requests and ensure regulatory timelines are met.
• Track and trend grievances and appeals and ensure regulatory timelines are met.
• Help staff prepare for and successfully complete state and federal audits.
• Prepare documents for PACE audit desk reviews and assist regulators onsite with navigating the EMR to access required information.
• Assist with audit plans and conduct internal and external audits of workforce and provider compliance with state and federal regulations and applicable contractual obligations.
• Facilitate the gathering and validation of data for the annual HOS-M survey, with the goal of maximizing participation.
• Complete required documentation accurately and on time.
• Protect privacy and maintain the confidentiality of company procedures and information about employees, participants, and families.
• Follow GMWP policies and procedures and participate in required Quality Improvement activities, staff training, and meetings.
• Perform other duties as assigned.

Benefits

• Generous pay and a comprehensive benefits package focused on health and wellness.
• 11 paid holidays, 16 days of PTO, and 5 days of sick time.
• A 5% employer match to the 403(b) retirement plan.
• No on-call time.
• Annual education allowance and support for professional growth.

What This Job Offers

• Job Type: Full-time