Quality & Compliance Specialist

St. Paul's Senior Services•San Diego, CA

About The Position

San Diego’s St. Paul's PACE program (Program of All-Inclusive Care for the Elderly). This innovative program is for individuals 55 years or older, who are living with chronic illness, or disabilities and need coordinated medical care to continue living as independently as possible in their home and community. The healthcare teams at St. Paul’s PACE provide a hands-on approach coordinating medical, social, and home care services so individuals no longer need to manage their medical care alone. This is a Temporary Full-time position with an anticipated duration of 4 months, with the possibility of extension. The typical schedule for the position is Monday - Friday, 8:00AM - 4:30PM. Job Summary: 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.

Requirements

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.
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.
YOU MUST BE ABLE TO CLEAR FINGERPRINTS THROUGH DOJ AND FBI IN ADDITION TO A DRUG SCREEN CLEARANCE.

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.
Experience in health-care or aging services compliance highly desirable.

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 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