Quality Coordinator

Kintegra Health•Gastonia, NC

73d

About The Position

The Quality Coordinator develops and implements the Senior TLC PACE program’s quality improvement (QI) program under the general direction of the Medical Director and Quality and Compliance Manager. The role includes maintaining and updating the annual QI plan; developing and implementing program-wide and center-specific quality indicators; managing data; educating and training staff; preparing routine and special reports; and coordinating improvement efforts that arise from monitoring activities. The position reports to the Quality & Compliance Manager and may supervise one to two Quality Support Staff. The coordinator supports regulatory compliance and quality initiatives through audit data management, oversight of service determination requests, appeals and grievances, quality committee activities, corrective action plans, root cause analysis, and external reporting. The role also coordinates program-level quality projects, assists with audits, communicates urgent health and safety concerns, and orients staff and contract providers to Senior TLC’s Quality Program.

Requirements

Bachelor’s or associate degree in nursing preferred.
Two years of experience in healthcare quality improvement.
One year of experience working with the frail elderly population.
Ability to communicate efficiently and effectively in a collaborative manner.
Experience with Electronic Medical Record systems.
Proficiency in Microsoft Office Suite programs, at minimum Word, Excel, and PowerPoint.
General understanding of behavioral patterns and attitudes common among the aging population served and staff.
Ability to learn new tasks quickly and efficiently.
Solid analytical and logical skills.
Ability to deal patiently and fairly with staff, participants, and others.
Ability to maintain effective working relationships and foster teamwork.
Ability to work independently and solve complex problems, make sound judgments based on available assessments and data, and act accordingly.
Flexibility, innovation, good interpersonal skills, and ability to prioritize multiple functions or tasks simultaneously.
Medical clearance for communicable diseases and up-to-date immunizations before direct participant contact.

Nice To Haves

Clinical background preferred.
NAHCQ certification preferred.

Responsibilities

Support and assist with creating and maintaining PACE Audit Universe Data Sets required by CMS regulations.
Assist Center Managers in ensuring the Service Determination Requests, Appeals, and Grievances process meets regulatory requirements, and advise the IDT on those requirements.
Oversee internal and external third-party appeals of denied service requests and coordinate and lead appeals beyond first-level reconsideration.
Review the PACE program’s QI program annually, update the plan as appropriate based on input from the Quality Committee and Leadership Team, communicate applicable policies and procedures, and prepare presentations for the STLC Board of Directors.
Oversee development and implementation of program-wide and center-specific quality indicators; plan and oversee staff education on QI activities and techniques; support staff engagement activities; assist with statistical analysis; and implement the annual Quality Plan and Quality Workplan.
Schedule, coordinate, and facilitate monthly and quarterly site QI Committee meetings.
Coordinate and participate in national and state PACE quality management initiatives, including engagement with the NC PACE Quality Committee.
Oversee QI data collection, entry, analysis, and assessment; ensure reported statistical data is accurate, timely, and complete; and submit data to relevant systems such as HPMS, ePace, and NC Benchmarking.
Facilitate Corrective Action Plans as directed, including identifying broader problems, developing and implementing improvement plans, and evaluating their effectiveness.
Oversee completion of Level II root cause analysis reports and submit them to DHB and CMS within required timelines.
Create monthly and quarterly CMS call agendas and support the account manager in facilitating meetings.
Coordinate and facilitate program quality projects and work with the Quality Manager on organizational quality projects at the program level.
Attend committee meetings to coordinate program quality initiatives and update the Senior TLC quality initiatives tracking system.
Attend Participant Advisory Committee meetings to share participant rights, including grievance and appeal rights, and program quality initiatives.
Document QI projects generated by the Quality Committee for reporting to the STLC Leadership Team(s) and Board of Directors.
Participate in priority setting with the Leadership Team, in consultation with staff and participants, and determine performance improvement priorities.
Assist in collecting and providing supporting documentation for external audits.
Update the findings tracking log for internal noncompliance and work with the supervisor and Compliance Department on root causes and follow-up actions.
Immediately communicate problems that threaten participant or staff health and safety to the Senior TLC Executive Program Director and Medical Director, to support development of required corrective plans within 24 hours.
Orient staff and contract providers to Senior TLC’s Quality Program; assist with quality-related complaints between consumers and program management; and ensure compliance with Federal, State, and Local laws and regulations alongside the Compliance Department.
Perform additional duties as assigned by the Medical Director, Executive Director, Quality & Compliance Manager, Executive Program Director, or Director of Quality and Corporate Compliance.