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The Director of Compliance and Quality primary focus is the development, implementation, and day-to-day operations of an effective compliance and quality program for CHS PACE. This position will report to the CHS VP of Compliance and Quality and serve as a member of CHS PACE senior management.

Responsibilities

General Compliance

The CHS PACE Director of Compliance and Quality job duties include:

• Develop and update compliance policies and procedures.
• Ensure annual risk assessments are completed and priority risks are identified in an annual monitoring and auditing work plan that is approved by the appropriate CHS Compliance Committee (depending on affiliate).
• Identify proper resources and strategies necessary to address risks and developing and managing an annual compliance budget.
• Ensure the resolution of any potential or actual instances of noncompliance.
• Report on a periodic basis, as directed, to the Board of Directors (the “Board”), the CEO, other senior management, and the Compliance Committee regarding the activities and status of the Organization’s Compliance Program, including:
  • the identification, investigation, and resolution of potential or actual instances of noncompliance;
  • the results of auditing and monitoring activities and risk assessments, including the effectiveness of the Compliance Program; and
  • any instances of government compliance investigation, compliance enforcement or compliance penalties such as Notices of Non-compliance (observations, CARs, ICARs), Warning Letters or more formal sanctions.
• Develop and implement training programs regarding the Organization’s Compliance Program;
• Develop and maintain compliance reporting mechanisms that are accessible and confidential and that allow employees and contractors [including First Tier, Downstream or Related Entities (“FDRs”)] to report suspected fraud, waste, and abuse and other non-compliance on an anonymous basis and without fear of retaliation.
• Develop and maintain effective lines of communication between the Compliance Officer and members of the Compliance Committee, senior leadership, employees, and contractors, including receiving regular reports on the results of auditing and monitoring activities and widely publicizing compliance policies and procedures throughout the Organization and its contractors.
• Responding to reports of compliance issues concerning the Organization, including compliance concerns involving contractors, and coordinating investigations and developing corrective action plans.
• Ensure instances of fraud or other misconduct is reported to the appropriate NBI MEDIC, CMS, and/or the State Administering Agency and other state-specific entities as required, when the Organization determines that such a report is appropriate in accordance with the Compliance Program policies and procedures.
• Maintain appropriate documentation regarding the Compliance Program.

Quality

• Manage day-to-day activities of the PACE Quality team.
• Work with leadership and clinical staff to develop and implement the organizational quality plan that results in achieving desired metrics/outcomes. Will work collaboratively to support the activities, processes, and policies resulting in high quality participant care driven by system-wide clinical practices and standards.
• Oversees the development and adherence with Performance Improvement Projects (PIPs) for each affiliate/business line.
• Performs root cause analysis in areas underperforming to ensure PIPs are appropriately targeting “cause and effect.”   
• Serves as a subject matter expert (SME) for medical quality and patient safety issues. Leads the development and adoption of an organization-wide culture of quality and safety.
• Participates in key committees aimed at alignment of clinical programs, promotion of clinical standardization, and improvement of quality and safety.
• Responsible for compliance with regulatory and accreditation standards related to Quality Assurance and Performance Improvement (QAPI).
• Chairs the Quality Steering Team meetings and ensures implementation of actions to achieve goals.
• Coordinates and oversees data collection and analysis, reporting, and follow-up related to quality measures.
• Regularly and effectively communicates quality processes and updates to all levels of leadership and staff.
• Develops short and long-range goals and objectives in collaboration with the medical staff and Executive Team.
• Provides the CHS VP: Compliance & Quality and the Chief Compliance Officer (CCO) with reports and recommendations to be shared with the Executive Team and Board members.
• Regularly checking the CMS website for relevant new or revised guidance materials, and making recommendations to the Board for incorporating new or revised guidance into the Quality Program, as appropriate.

Qualifications

The ideal candidate should have the following qualifications:

• Minimum of five (5) years experience working with in Compliance or Quality programs, preferably with PACE, MA, MA-PD or PDP programs. Supervisory experience preferred.
• Bachelor’s degree in related field.
• Demonstrated skills in fiscal management, utilization of analytical and statistical tools, data analysis, and outcomes management.
• Knowledge of and ability to apply process improvement theory and process mapping.
• Strong computer skills and competent with statistical applications and graphics.
• Intermittent Driver - Valid driver's license and automobile insurance per Company policy.
• Able to travel to off-site locations.
• Able to work with minimal supervision and exercise a high degree of discretion and independent judgment.
• Able to prioritize multiple job responsibilities, exercise critical thinking skills, and effectively handle stress.

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.