Quality and Compliance Manager

Elevation Senior Services•Colorado Springs, CO

1d•$82,500 - $94,875•Onsite

About The Position

The Quality & Compliance Manager for the PACE (Program of All-Inclusive Care for the Elderly) program plans, implements, monitors, and evaluates the Quality Assurance and Performance Improvement (QAPI) program. The role ensures compliance with federal, state, and local regulations and PACE standards, with a focus on improving participant outcomes, enhancing safety, and promoting continuous quality improvement across clinical, operational, and administrative areas. The manager leads quality improvement and compliance activities, including audits, incident investigations, regulatory reporting, privacy incident response, and preparation for CMS and state audits and surveys. The position collaborates with interdisciplinary teams, department heads, leadership, regulators, participants, contracted providers, and vendors. It also supervises and develops the quality and compliance teams and promotes a culture of safety, accountability, ethics, and participant-centered care.

Requirements

Bachelor’s degree in nursing, public health, healthcare administration, or a related field.
At least 5 years of experience in healthcare quality and/or compliance.
At least 2 years of supervisory or team leadership experience.
Strong knowledge of CMS PACE regulations (42 CFR Part 460), QAPI requirements, and HIPAA Privacy and Breach Notification Rules.
Data analysis and reporting skills, including experience with EHRs, quality reporting tools, and data visualization.
Knowledge of quality improvement methods, including PDSA, Lean, Six Sigma, and root cause analysis.
Investigation and documentation skills, with sound judgment and discretion when handling sensitive information.
Project management skills and ability to meet multiple regulatory deadlines.
Strong written and verbal communication skills with staff, leadership, regulators, and participants.
Integrity, ethical judgment, and ability to work independently and collaboratively.

Nice To Haves

Experience in a PACE, long-term care, or senior services setting.
CPHQ (Certified Professional in Healthcare Quality), CHC (Certified in Healthcare Compliance), or CHPC (Certified in Healthcare Privacy Compliance) certification.
Lean Six Sigma certification.
RN license.

Responsibilities

Develop, coordinate, and lead the QAPI program in accordance with CMS, state, and PACE-specific regulations.
Collaborate with interdisciplinary team members and department heads to identify performance gaps, analyze data, and implement quality improvement initiatives.
Collect, analyze, and report quality and compliance metrics, including clinical outcomes, participant satisfaction, grievances, adverse events, utilization, and privacy incidents.
Facilitate and document QAPI committee meetings, maintaining records of activities, goals, benchmarks, and follow-up actions.
Monitor and manage incident reporting, including investigations, root cause analyses, and corrective actions.
Lead quality improvement projects using PDSA, Lean, or Six Sigma, and build systems to monitor and improve care delivery, performance, and efficiency.
Support day-to-day compliance program operations, including the annual compliance risk assessment, auditing and monitoring work plan, and Compliance Committee.
Develop, review, and maintain compliance and privacy policies and procedures on an established review cycle, and help departments keep their procedures current.
Conduct regular audits, chart reviews, and risk assessments to ensure compliance with internal policies and external requirements.
Intake, investigate, and resolve potential HIPAA privacy incidents, including breach risk assessments and notifications to individuals, OCR, and the state as required; track and trend results.
Investigate potential noncompliance and fraud, waste, and abuse reports, and direct corrective action and retraining.
Coordinate regulatory reporting and responses, including HPMS submissions, CMS and state incident reporting, and Complaints Tracking Module resolution.
Serve as a primary contact for CMS and state audits and surveys, including audit universe preparation, responses, and corrective action plans.
Monitor compliance of contracted providers and vendors, including OIG/SAM exclusion screening.
Develop and deliver staff training on quality improvement, regulatory compliance, HIPAA privacy, and fraud, waste, and abuse.
Stay current on healthcare, PACE, and privacy regulation changes; assess their impact and update policies and practices accordingly.
Promote a culture of safety, accountability, ethics, and participant-centered care throughout the organization.
Supervise, develop, and support the quality and compliance teams, including hiring, training, workload assignment, and performance management.
Perform other duties as assigned by the Vice President of Quality & Compliance.
Support the company’s mission, vision, and core values; provide exceptional customer service; and handle confidential information in accordance with HIPAA guidelines.
Support a collaborative work environment through courteous, helpful, and professional behavior.
Practice individual time management, efficiency, and effectiveness, and participate in continuous improvement efforts.
Adhere to and support company policies and procedures, and practice safe work habits.
Bring ideas, problems, and concerns forward and participate in resolution and implementation.
Complete regulatory compliance training within prescribed deadlines and attend required meetings.
Maintain required skills and knowledge, including written and verbal communication, industry best practices, and computer competency.