Job Overview
We are seeking a dedicated and detail-oriented Quality Specialist to join our team.
The Quality Specialist is responsible for supporting the design, implementation, and monitoring of quality improvement activities within the PACE program. This position ensures that all services meet the highest standards of care, compliance, and participant satisfaction. The Quality Specialist works closely with interdisciplinary teams and assists the Medical Director at the local level in coordinating and facilitating the Quality Management (QM) Committee meetings. Additionally, the Quality Specialist manages the appeals and grievances process, ensuring timely and thorough tracking, investigation, and resolution.
Responsibilities
Quality Improvement Initiatives:
- Assist in the development, implementation, and evaluation of the PACE Quality Assessment and Performance Improvement (QAPI) program.
- Collaborate with interdisciplinary teams to identify opportunities for improvement in clinical and operational processes.
- Lead quality improvement projects and monitor progress to achieve set goals.
- Assist the Medical Director at the local level in coordinating and facilitating the QM Committee meetings, ensuring all relevant data and reports are presented and discussed.
Regulatory Compliance:
- Ensure compliance with PACE regulations, including CMS, state, and local requirements.
- Assist in preparing for audits, surveys, and other regulatory assessments.
- Maintain knowledge of current quality and regulatory standards and ensure program adherence.
Data Management and Reporting:
- Collect, manage, and analyze data on quality indicators, participant outcomes, and satisfaction.
- Prepare and present reports to the Chief Medical Officer, leadership team, and regulatory agencies.
- Monitor clinical outcomes and trends, identifying areas requiring corrective action.
Appeals and Grievances Management:
- Track, investigate, document, follow up, and resolve participant appeals and grievances in a timely manner.
- Ensure compliance with federal and state regulations regarding the appeals and grievances process.
- Report on trends and issues, ensuring continuous improvement in response and resolution processes.
Training and Education:
- Provide training to staff on quality improvement initiatives, regulatory compliance, and performance standards.
- Support staff in the development and implementation of best practices for care delivery.
Incident Management:
- Assist with tracking, investigating, and resolving incidents related to participant care and operations.
- Work closely with the CMO and interdisciplinary team to develop corrective actions and improve participant outcomes.
- Occasional travel to other PACE centers or external locations for meetings and training and will cover both Kokomo and Jeffersonville sites.
- Other duties as assigned.
Qualifications
- Bachelor’s degree in healthcare administration, public health, nursing, or a related field required
- 3+ years of experience in healthcare quality improvement, with a focus on senior care, long-term care, or PACE programs
- In-depth knowledge of CMS PACE regulations, Medicaid managed care guidelines, and elder care quality standards.
- Experience with regulatory audits, corrective action planning, and QAPI implementation.
- Strong communication and relationship-building skills with internal teams and external agencies.
- Demonstrated commitment to person-centered, community-based care for older adults.
- Exceptional leadership, communication, and change management skills.
- Deep understanding of geriatric care models, healthcare operations, and capitated payment systems.
- Cultural competence and a strong commitment to equity and inclusion in aging services.
- Strong communication and interpersonal skills written and oral; demonstrated ability to influence outcomes and work effectively with all organizational levels.
- Commitment to demonstrating the highest standard of ethical conduct and integrity; strong willingness to continually embrace personal and professional development
- Deep commitment to serving older adults and vulnerable populations.
- Proficient with computers and Microsoft Office.
PREFERRED
- Certified Professional in Healthcare Quality (CPHQ) preferred.
- Master’s degree in healthcare administration, Business Administration, Public Health, or related field strongly preferred.
Job Type: Full-time
Expected hours: No less than 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person