quality specialist San Diego, CA
Job description
Position Summary:
Under the supervision of the Quality Assurance Supervisor lead by the Quality Manager, assist in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program. The Quality Assurance Coordinator will be responsible for data collection, management and data submission in accordance with CMS, State, accrediting bodies, and the San Diego PACE. In close coordination with QA Manager, assists with the investigation of incidents, grievances, appeals, potential quality of care concerns and as assigned. Ensures grievances/complaints are processed in accordance with applicable state and federal regulations, compliance standards, and policies and procedures. QA Coordinator will assist QA Supervisor and QA Manager in annual review and update of the quality improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, education and training of program staff around quality improvement, preparation of routine and special reports, and coordination of improvement efforts arising from monitoring activities.
Essential Functions of the Job:
Tracks real time data and provides feedback to Interdisciplinary team (IDT) by attending IDT meetings as assigned, to ensure quality, compliance, and safety elements are documented, including service delivery requests, grievances, appeals, ER visits, hospitalizations, Level I & Level II incidents, Falls, and other metrics as needed.
Provides quality and compliance support to the IDT team. Guides the IDT and Center Manager on recognizing and documenting periodic participant assessments and care plans.
Gather data from a variety of sources and organize it within spreadsheets and other software tools for analysis and interpretation. Assist with gathering all data for Level I reporting and enter data into the Health Plan Management System (HPMS)
Analyze PACE quality, compliance, and safety data, making suggestions when potential issues arise.
Works with various departments and management to assist in addressing potential quality, compliance, and safety issues.
Provides data entry within organizational data systems, as well as regulatory data systems of the State and Federal government.
Prepares data for Quality & Compliance presentations as needed.
Assists in the Plan-Do-Study-Act (PDSA) processes of Quality Improvement.
Manage large data sets and organize them into an interpretable format using Excel and other software tools.
Assists in developing new QI projects.
Assists in reporting to State and Federal regulators.
Must be able to provide written and verbal communication with all staff, caregivers, participants, and community at large.
Ability to organize and manage large volumes of data.
Must be detail-oriented and organized with excellent customer service skills.
Demonstrate integrity, discretion and practice objective problem solving.
Ability to collect, organize, and report meaningful data for decision making while using spreadsheets or other data processing software.
Skilled in identifying and recommending problem resolution.
Demonstrate experience in quality assurance and performance improvement activities.
Reviews electronic medical records for data collection, for investigation purposes and for medical records documentation quality checks.
Identifies opportunities for Quality improvement initiatives. Assist the Quality Assurance Supervisor and the Quality Assurance Manager in developing and tracking plans of action for improvement processes.
Enhance professional growth, and development through participation in educational programs, current literature, in-service meetings, and workshops.
Stay up to date with the most updated Federal, State and PACE regulations. Assist with annual review of Policies & Procedures as assigned.
Assist in putting together electronic files and documents for CMS quarterly calls and for CMS/State audits.
Assist in putting together meeting materials, reports, and presentations as assigned. Assist in drafting and mailing letters related to notice of action (NOA), grievances, and appeals as assigned.
Maintain knowledge of policies and procedures and complete tasks in accordance with applicable regulatory requirements, external laws, and accreditation standards as they relate to PACE and Quality Assurance.
Attend meetings as required and participate in committees as directed.
Maintain and support a culture of compliance ethics and integrity.
Other duties as directed.
Job Requirements:Education Required (Minimum level of education):
- Associate’s Degree or higher in a health-related field (Medical Assistant, Health Information Specialist), in lieu of an associate degree 2 years of relevant experience and a High School Diploma is acceptable.
- Bachelor’s degree in quality assurance, business administration, or relevant field preferred.
Experience Required (Minimum level of experience):
- Minimum two years’ experience in healthcare, preferably in Quality Improvement; familiarity with quality improvement processes.
- Minimum of two years of demonstrated experience in an analytical capacity, which include the collection, organization, and reporting of data.
- At least 1 year experience working with the frail or elderly population. Bilingual (English/Spanish) is helpful.
Technical Knowledge and Skills Required to Perform the Job: Proficient in Microsoft Office Suite (Word, Powerpoint, Excel, Outlook, Visio) to present data in easily understood formats; advanced computer skills to learn specific applications. Meet a standardized set of competencies for the specific position description established by SYHC PACE and approved by CMS.
Equipment Used: Networked personal desktop, laptop computer, document center, fax, copier/scanner and telephone.
Working Conditions and Physical Requirements: Physical clearance for reaching, bending, stooping, crouching, kneeling and grasping; have full range of motion; ability to lift 50 lbs; need to lift and transfer participants; T.B. clearance; prolonged periods of sitting and standing.
Universal Requirements:
Pre employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre employment PPDs
About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
