Quality & Compliance Specialist

St Pauls Senior Services•SAN DIEGO, CA

About The Position

Under the direction of the Quality and Compliance Manger, the Quality and Compliance Specialist is responsible for ensuring that the healthcare organization meets all regulatory and accreditation standards. This role involves developing, implementing, auditing and monitoring quality improvement initiatives, as well as ensuring compliance with local, state, and federal regulations. The specialist will work closely with clinical and administrative staff to promote a culture of safety, quality, and compliance. Quality and Compliance specialists play a vital role in assisting with the implementation of the Quality Assessment and Performance Improvement Plan (QAPI) for the St. Paul’s PACE program.Duties and Responsibilities: Assures full implementation of the annual QAPI Plan, performs contract facility quality assurance audits to ensure quality participant care, collaborate with clinical staff to develop and implement evidence-based practicesLead quality improvement initiatives aimed at enhancing patient care and safety and analyze data to identify trends and areas for improvement, and recommend corrective actions.Conduct regular audits and assessments to ensure compliance with healthcare regulations, including HIPAA, OSHA, CMS, and specific state regulations.Develop and implement policies and procedures to address compliance issues, with a focus on adherence to state-specific healthcare regulations.Monitor and ensure compliance with state licensing requirements, including timely renewals and adherence to operational standards mandated by the state. Conduct risk assessments to identify potential areas of non-compliance with state regulations and work with departments to develop mitigation strategies.Provide training to staff on compliance and quality standards, including new regulations and best practices. Develop educational materials and conduct workshops or seminars to promote a culture of quality and compliance.Ensures staff integration into the QAPI process through Continuous Quality Improvement education and developing opportunities for input.Manage the grievance and incident reporting process, including investigating and documenting case details, and ensuring appropriate corrective actions are taken.Maintain detailed records of compliance activities, audit results, and quality improvement initiatives.Participates in quality assurance-related communication between contract facilities and St. Paul’s PACE Interdisciplinary Teams.Other duties as assigned Qualifications and Requirements:Education: Bachelor’s degree in Healthcare Administration, Nursing, or a related field. Certified Professional in Healthcare Quality (CPHQ) or Certified in Healthcare Compliance (CHC) is preferred. Experience: Must have a minimum of one year’s experience working with the frail or elderly. Proven experience in healthcare auditing or quality assurance/improvement. One to three years or more years of relevant compliance experience and/or quality improvement is required; experience in health-care or aging services compliance highly desirable. Experience in a clinical setting is a plus.Skills and Knowledge: Strong knowledge of healthcare regulations and accreditation standards.Excellent written and verbal communication, with specific ability to maintain accurate records.Effective in project management/ LEAN Process ImprovementAbility to manage multiple projects and meet deadlinesStrong ability in auditing and monitoringEffective data collection and analysis skills/knowledge of basic statistical principles Excellent analytical and problem-solving skillsStrong communication and interpersonal skillsMaintains the confidentiality of all company procedures, results, and information about residents and participants, clients or familiesMaintains courteous, helpful and professional behavior on the job Physical Demands and Working Conditions: Visual, Hearing and Communication Requirements: Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Must be able to communicate verbally with all staff, vendors, and clients. Physical Requirements: Requires manual and finger dexterity and eye/hand coordination, the ability to use department equipment and the ability to lift/carry up to 30 lbs. using appropriate body mechanics. Pressure Factor: Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled appointments. Subject to people that may have the potential for verbal or physical aggression.

Requirements

Bachelor’s degree in Healthcare Administration, Nursing, or a related field
Must have a minimum of one year’s experience working with the frail or elderly
Proven experience in healthcare auditing or quality assurance/improvement
One to three years or more years of relevant compliance experience and/or quality improvement is required; experience in health-care or aging services compliance highly desirable
Strong knowledge of healthcare regulations and accreditation standards
Excellent written and verbal communication, with specific ability to maintain accurate records
Effective in project management/ LEAN Process Improvement
Ability to manage multiple projects and meet deadlines
Strong ability in auditing and monitoring
Effective data collection and analysis skills/knowledge of basic statistical principles
Excellent analytical and problem-solving skills
Strong communication and interpersonal skills
Maintains the confidentiality of all company procedures, results, and information about residents and participants, clients or families
Maintains courteous, helpful and professional behavior on the job
Requires corrected vision and hearing to normal range, with or without reasonable accommodation
Must be able to communicate verbally with all staff, vendors, and clients
Requires manual and finger dexterity and eye/hand coordination, the ability to use department equipment and the ability to lift/carry up to 30 lbs. using appropriate body mechanics
Requires working under stressful conditions
Working conditions may be noisy and crowded and fluctuating indoor temperatures
Moderate pressure to meet scheduled appointments
Subject to people that may have the potential for verbal or physical aggression

Nice To Haves

Certified Professional in Healthcare Quality (CPHQ) or Certified in Healthcare Compliance (CHC) is preferred.
Experience in a clinical setting is a plus.

Responsibilities

Assures full implementation of the annual QAPI Plan
Performs contract facility quality assurance audits to ensure quality participant care
Collaborate with clinical staff to develop and implement evidence-based practices
Lead quality improvement initiatives aimed at enhancing patient care and safety
Analyze data to identify trends and areas for improvement, and recommend corrective actions
Conduct regular audits and assessments to ensure compliance with healthcare regulations, including HIPAA, OSHA, CMS, and specific state regulations
Develop and implement policies and procedures to address compliance issues, with a focus on adherence to state-specific healthcare regulations
Monitor and ensure compliance with state licensing requirements, including timely renewals and adherence to operational standards mandated by the state
Conduct risk assessments to identify potential areas of non-compliance with state regulations and work with departments to develop mitigation strategies
Provide training to staff on compliance and quality standards, including new regulations and best practices
Develop educational materials and conduct workshops or seminars to promote a culture of quality and compliance
Ensures staff integration into the QAPI process through Continuous Quality Improvement education and developing opportunities for input
Manage the grievance and incident reporting process, including investigating and documenting case details, and ensuring appropriate corrective actions are taken
Maintain detailed records of compliance activities, audit results, and quality improvement initiatives
Participates in quality assurance-related communication between contract facilities and St. Paul’s PACE Interdisciplinary Teams
Other duties as assigned