PACE Director of Quality & Compliance

Reports to: Executive Director

Job Summary:

The Director of Quality and Compliance for the PACE (Program of All-Inclusive Care for the Elderly) Program will oversee and manage all aspects of quality assurance, compliance, and regulatory adherence for the PACE program. This role ensures that the program operates in full compliance with federal, state, and local regulations, as well as upholds the highest standards of care for the elderly participants. The Director will lead efforts to continuously improve program quality, enhance participant satisfaction, and drive performance excellence across the organization.

Key Responsibilities:

 1.    Regulatory Compliance Management:

·         Ensure adherence to all PACE-related federal, state, and local regulations, including CMS (Centers for Medicare & Medicaid Services) and state-specific requirements.

·         Monitor and interpret updates to regulatory policies, and adjust organizational practices as necessary to remain compliant.

·         Act as the primary liaison between the organization and regulatory agencies, ensuring timely reporting and response to audits, surveys, and inspections.

 2.    Quality Assurance and Improvement:

·         In collaboration with the Medical Director develop, implement, and evaluate quality improvement initiatives to ensure high standards of care, safety, and service delivery for participants.

·         Collaborate with clinical and operational teams to analyze performance metrics and identify opportunities for continuous improvement.

·         Oversee the development and execution of corrective action plans (CAPs) for any areas of deficiency, ensuring timely resolution.

 3.    Risk Management and Reporting:

·         Lead risk assessment processes to identify potential compliance and quality issues, minimizing risk to the organization and participants.

·         Develop and implement risk mitigation strategies, including monitoring trends, identifying patterns, and taking proactive actions.

·         Ensure the organization is prepared for external audits and inspections, managing all compliance-related documentation and reporting.

 4.    Staff Training and Development:

·         Develop and conduct ongoing training programs for staff on compliance, quality standards, and regulatory requirements.

·         Foster a culture of compliance and continuous improvement across the organization by leading educational initiatives and creating awareness.

·         Provide guidance and support to staff on regulatory changes, quality standards, and best practices.

 5.    Participant Care and Satisfaction:

·         Advocate for participants’ safety and satisfaction, ensuring that their rights and well-being are protected in all aspects of the program.

·         Work closely with interdisciplinary teams to ensure person-centered care is at the core of all service delivery and interventions.

·         Monitor and evaluate participant feedback, addressing any concerns or complaints in a timely and professional manner.

 6.    Leadership and Strategic Planning:

·         Serve as a key member of the senior leadership team, contributing to the strategic direction of the PACE program.

·         Collaborate with leadership to set annual goals for quality and compliance performance and develop strategies to achieve these objectives.

·         Ensure alignment of quality and compliance initiatives with organizational goals and values.

 7.    Data Collection and Analysis:

·         Oversee the collection, analysis, and reporting of quality and compliance data to track program performance and outcomes.

·         Utilize data to drive decision-making and identify areas for operational improvements and resource allocation.

·         Prepare reports and presentations for senior leadership and external stakeholders regarding compliance, quality, and performance metrics.

 8.    Technology and EMR

·         Serving as the primary point of contact for EMR-related issues, providing guidance and troubleshooting support to team members.

·         Leading training sessions and providing ongoing support for staff to ensure efficient use of the EMR system.

·         Collaborating with IT and management teams to implement updates and resolve system issues.

·         Continuously staying updated on new features and best practices for the EMR system to ensure the organization is utilizing the platform to its full potential.

Qualifications:

·         Bachelor’s degree in healthcare administration, nursing, public health, or a related field (Master’s degree preferred).

·         Minimum of 4 years of experience in quality management, compliance, or regulatory affairs in a healthcare setting, with at least 2 years in a leadership role.

·         Knowledge and experience with PACE program operations and regulations (CMS and state-level).

·         Strong understanding of healthcare regulations, accreditation standards, and compliance protocols.

·         Proven track record in leading quality improvement initiatives and risk management programs.

·         Exceptional leadership, communication, and interpersonal skills.

·         Ability to work collaboratively across departments and with interdisciplinary teams.

·         Strong analytical and problem-solving skills, with the ability to drive results.

·         Certification in Healthcare Quality (CHCQM, CPHQ) or other relevant certifications preferred.

 Physical Demands:

·         Ability to work in an office environment and attend in-person meetings.

·         Occasional travel to program sites or regulatory meetings may be required.

 Work Environment:

·         A collaborative, team-oriented atmosphere within a dynamic, fast-paced healthcare environment.

·         Commitment to participant-centered care and service excellence.