PACE Quality Analyst I (Full Time - Temp)

Position Summary:

Under the supervision of the Quality Assurance Supervisor and lead by the Quality Manager assists in all activities related to the SD PACE (Program of AllInclusive Care for the Elderly) Quality Assurance and Performance Improvement (QAPI) Department. The QAPI Analyst will be responsible for collecting documenting tracking and monitoring/managing data in accordance with CMS (federal) regulations DHCS (state) regulations accrediting body regulations and requirements and San Diego PACE policies and procedures. In close coordination with QAPI and Operational Leadership assists with the investigation and resolution of incidents grievances appeals and potential quality of care concerns as assigned in accordance with applicable state and federal regulations compliance standards and policies and procedures. The QAPI Analyst will assist in the annual review of the QAPI Work Plan development implementation and monitoring of programwide and centerspecific performance measures data management education and training of program staff around QAPI initiatives preparation of routine and special reports and coordination of improvement efforts arising from monitoring and/or audit activities.

Essential Functions of the Job:

QAPI Analyst Job Functions:

• Collects and tracks real time data and provides feedback and guidance to the Interdisciplinary team (IDT) by participating in IDT meetings to ensure QAPI elements are documentedin accordance with applicable state and federal regulations compliance standards and policies and procedures.
• Provides QAPI support to the IDT by guiding the IDT and Center Manager on recognizing and documenting elements of performance that are at risk of being out of compliance (i.e. Care Plans > 180 days).
• Gathers data from a variety of sources and organizes it into the correct format for analysis and interpretation.
• Collects tracks and monitors/manages all data for Level I reporting in order to enter it quarterly into the Health Plan Management System (HPMS).
• Analyzes SD PACE QAPI data and makes recommendations for improvement(s) when areas of opportunity are identified. Assists in developing new QAPI projects and then leads those projects using PlanDoStudyAct (PDSA) processes.
• Collaborates with various departments and stakeholders to assist in addressing potential QAPI issues.
• Analyzes and prepares data for QAPI presentations as needed.
• Manages large data sets and organizes them into an interpretable format using the appropriate software tools.
• Assists in reporting to State and Federal regulators. Assists in putting together electronic files and documents for CMS quarterly calls and for CMS/State audits.
• Assists in putting together meeting materials reports and presentations as assigned.
• Demonstrate experience in quality assurance and performance improvement activities.
• Reviews electronic health records for data collection for investigation purposes and for medical records documentation quality checks.
• Assists in drafting and mailing letters related to notice of action (NOA) grievances and appeals as assigned.
• Maintains knowledge of policies and procedures and completes tasks in accordance with applicable regulatory requirements external laws and accreditation standards.
• In collaboration with the IDT Moderator monitors and tracks grievances complaints and dissatisfaction from participants to identify trends. Assists leadership in service recovery efforts.

IDT Moderator Job Functions:

• Takes responsibility for the development implementation & execution of participant care. Facilitates activities related to new participants in coordination with the IDT Team including new participant orientation.
• Coordinates all IDT Team Meetings including care planning and implementation; preparation for interdisciplinary conferences daily meetings and family conferences; and all related followups. This includes the performance of routine care plan audits and all related followup with disciplines interventions and evaluations in participants care plans.
• Participates in the continued development of the team to improve the team decision making process providing support to the team to troubleshoot advise teach coordinate and deliver care and service to participants.
• Serves as liaison between individual program disciplines and community service providers. Ensures appropriate hospital and Skilled Nursing Facility (SNF) transitions are coordinated and implemented to uphold the SD PACE standard of care.
• Drives IDT engagement and ensures team decisions are documented.
• Performs all IDT Moderator responsibilities and function on an as needed basis.

General Employee Job Functions:

• Must be able to provide written and verbal communication with all staff caregivers participants and the community at large.
• Must be detailoriented and organized with excellent customer service skills.
• Demonstrate integrity discretion and practice objective problem solving.
• Attends meetings as required and participates in committees as directed.
• Maintains and supports a culture of compliance ethics and integrity.
• Enhances professional growth and development through participation in educational programs current literature inservice meetings and workshops.
• Other duties as directed.

Job Requirements:

Education Required (Minimum level of education):

• QAPI Analyst (I): High School diploma or GED Equivalent.
• QAPI Analyst (II): High School diploma or GED Equivalent.

Certifications/Licenses Preferred:

• Experience in chart review medical documentation coding or strong clinical background. Valid California drivers license with appropriate insurance.

Experience Required (Minimum level of experience):

• QAPI Analyst (I): 13 years of experience in working in quality or compliance in healthcare preferably in Quality Improvement or compliance; familiarity with quality improvement processes. Preferably 13 years of demonstrated experience in an analytical capacity which includes the collection organization and reporting of data.
• QAPI Analyst (II): 3 or more years of experience in working in quality or compliance in healthcare preferably in Quality Improvement or compliance; familiarity with quality improvement processes. 3 or more years of demonstrated experience in an analytical capacity which includes the collection organization and reporting of data. Previous work experience as a PACE QAPI Analyst I.

Verbal and Written Skills Required to Perform the Job:

• Excellent written and verbal communication skills with specific ability to maintain accurate records.
• Must have active listening ability and knowledge of adult learning modes required to train facilitate and motivate various staff in quality improvement activities.

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 SD 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 I9 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 108000 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 missiondriven team! San Ysidro Health has a longstanding 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 HIVrelated 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.