Job Description

Status: Exempt

Reports to: Director of Quality and Compliance

Job Summary: The Manager of Quality Assurance is a dynamic position that is responsible to evaluate, recommend and implement initiatives that will propel the organization to the next level for quality measurement. Will be responsible for programs and processes related to the LIFE Pittsburgh quality program. On a daily basis, will work with a wide variety of management and clinical/operational staff to ensure compliance with external reporting requirements and internal quality initiatives. This role will be responsible for the oversight of data collection and entry, initial analysis of quality, data display and interpretation, and reporting of this data to a wide range of clinical and administrative leaders both internally and externally. In addition, will lead and manage projects focused on quality initiatives and improved Participant care.

Essential Functions:

• Demonstrates and reflects a commitment to the mission and core values of LIFE Pittsburgh to support the elderly in maintaining their dignity and independence in the community within the PACE model of care.
• Will facilitate appropriate implementation, administration, and evaluation of Quality programs designed to improve Participants health and wellness and the quality and safety of clinical care received through the LIFE Pittsburgh program along with maintaining compliance with all Federal, State and PACE regulations.
• Conducts analytical review on adverse events, takes the lead in the follow-up and monitoring of outcomes and the development of correction plans for identified areas of risk. Root cause analysis and systems analysis will be utilized to identify causes and contributing factors in the occurrence of such events
• Will assist in the identification of clinical and service data trends, identifying variations in evidence-based medical practice and sub-standard performance and recommend opportunities for improvement.
• Will have oversight of the submission of information and data to the internal Quality Committee and management team in a fashion that facilitates identification of trends and area’s for improvement or success.
• Provides support and consultation to all staff assuring the implementation of strong quality improvement strategies using proven quality methods, tools/techniques
• Monitors the Quality Improvement Programs compliance with Federal, State and PACE regulations, maintain comprehensive centralized records of compliance review, audits, analysis, conclusions and actions to ensure ready access for review and follow-up for site visits and audits.
• Conducts concurrent and retrospective chart analysis for the purpose of identifying opportunities for improvement with Participant care.
• Monitors the Grievance Program in accordance with federal and state regulations. Works closely with the management team to ensure not only compliance with the program, but also satisfactory problem resolution in a timely manner and analyzes data for trends and development of best practice.
• Monitors all applicable compliance standards in regards to PACE regulations, OADLC, HIPAA, etc.
• Keeps abreast of changes in regulations as they apply to quality and PACE Programs as well as to relevant issues (e,g funding) and how and what indicators may be used.
• Facilitates department QI meetings, providing input regarding problem identification and resolution, continuous quality improvement (CQI), and other Participant care activities.
• Leads education to management and staff on the overall philosophical approach of the LIFE Pittsburgh Quality program, educates on monitoring methods and measurement techniques specific to quality indicators

Working Conditions:

• Works within the LIFE Pittsburgh Administrative Offices with occasional travel between LIFE Pittsburgh sites during all weather conditions. Occasional travel for other related functions/training.

Requirements

Knowledge /Skills / Abilities

• Must have a strong knowledge of Quality Management within a healthcare setting.
• Demonstrated clinical, quality assessment, and leadership experience; excellent communication, presentation and interpersonal skills
• Quality assessment, and training experience; knowledge of utilization review and third party payer criteria, regulatory requirements' and quality assessment criteria
• Ability to work independently and in collaboration with others.
• Excellent communication, presentation skills and interpersonal skills
• Proficient with Microsoft Office, data analysis and presentation tools.

Required Certification/License:

• Driver’s license and proof of automobile insurance
• Must have access to a vehicle for travel

Education/Experience:

• Bachelor’s Degree (Masters strongly preferred) in a healthcare or related field
• Certified Professional Healthcare Quality (CPHQ) certification preferred
• Must have 3-5 years’ experience in a progressive Quality position in a healthcare setting

The position description is intended to describe the essential functions of the position and the general duties and responsibilities associated with the position. It is not intended to be comprehensive in nature. In addition, jobs evolve overtime and; therefore, the description may not reflect the precise nature of the position at a given point in time. Staff may be asked to perform essential and non-essential functions at any time with or without notice.