Saint Joseph, Michigan
Quality Manager Job Opening in Saint Joseph, Michigan - Job Summary : The Quality Manager(QM) provides quality and utilization management expertise and collaboratively works with IDT to ensure optimal care delivery. The QM builds positive relationships with providers, troubleshoots issues in a timely manner, and builds strong collaborative relationships with staff, providers and facilities. Identifies and implements organization wide process improvement opportunities with team. Responsible for defining and meeting quality metrics. Manages overall quality improvement program of PACE with support from pertinent leadership and support staff. Serves as Compliance
Education : Business, Clinical or Health related degree.
Experience Minimum 1-year experience working with the frail elderly population. 2-4 years healthcare related field experience required, including quality and utilization review or related experiences. PACE experience preferred.
Number and Type of Employees Supervised (optional) : Clinical Application Analyst and Medical Records Clerk.
Licensure, Registry or Certification Required : Valid MI driver?s license preferred.
Special Training : Only acts within the scope of his or her authority to practice. Meet a standardized set of competencies for the specific position description established by PACE of Southwest Michigan and approved by CMS before working independently.
Immunizations: Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.
Specific Requirements and Considerations: May be subject to exposure of infectious wastes, diseases, conditions or hazardous chemicals, etc., including potential exposure to TB, AIDS, and/or Hepatitis B.
Key Responsibilities :
Develops annual QAPI plan and submits to Board and all federal and state agencies as required including quarterly progress reports.
Facilitates and completes all Level II reporting and all Root Cause Analysis activities per regulations.
Develops appropriate quality policies and procedures for PACE of Southwest Michigan with Medical Director and Executive Director.
Coordinates and facilitates regular Quality Committee Meetings and regular Compliance Meetings and maintains documentation of these efforts per PACE regulations in collaboration with Medical Director.
Works with the Medical Director and Chief Financial Officer on Part D activities, including fraud, waste, abuse and utilization. Coordinates identification of potential fraud, waste, and abuse committed by employees, participants and contractors with Compliance Committee.
Facilitates UR meetings with pertinent IDT members.
Coordinates with national initiatives for PACE quality management programs and process.
Coordinates provider monitoring process including onsite visits, complaint monitoring, staff education per requirements.
Demonstrates ongoing and up-to-date knowledge of governing rules, regulations and other applicable standards for PACE. Ensures compliance with all rules, laws and regulations which pertain to PACE of Southwest Michigan regarding quality and utilization. Including but not limited to care plan and service delivery compliance.
Directs all aspects of MPRO audits per requirements and regulations including all necessary follow up with IDT, MPRO and State.
Implements and coordinates pertinent chart audit process with IDT including internal audits to ensure program meets LOCD determinations per regulations.
Conducts and/or coordinates staff training for all quality matters including but not limited to emergency preparedness and required drills.
Participates in on call rotation as directed.
Serves on committees or teams as directed to support all quality and utilization efforts for the organization.
Skills and Knowledge
High level of autonomy is required for clinical and management decisions while reporting to Clinic Manager.
Excellent attention to details.
Excellent organizational skills.
Excellent verbal and written communication skills.
Ability to work a flexible work schedule.
Knowledge of physical, mental and social needs of frail older adults.
Effective skills in physical assessment and chronic disease management for frail older adults.
Able to work within the Interdisciplinary Team (IDT) setting.
Able to utilize basic computer skills in the workplace.
Able to utilize organization?s electronic medical record system.
Job Type: Full-time
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