STLC Quality Coordinator

Job Description

Job Description

Job Summary and Specifications

Job Title: Quality Coordinator

FLSA Status: Exempt

Salary Range: See Salary Scale

Job Summary: Under the general Direction of the Quality and Compliance Manager, develops and implements a Quality Improvement (QI) program for Senior Total Life Care, including an annual review and update of the quality improvement plan; development and implementation of program wide and center specific quality indicators; data management; education and training of program staff around quality improvement; preparation of routine and special reports; and coordination of improvement efforts arising from monitoring activities. Reports to the Quality and Compliance Manager.

Specifications

Education: Bachelor’s degree in nursing preferred, associate degree in nursing required.

Experience: 2 years in healthcare quality improvement. One year experience working with the frail elderly population.

Number and Type of Employees Supervised (opt): 1 to 2 - Quality Support Staff

Licensure, Registry or Certification Required: NAHCQ Preferred

Special Knowledge, Skills, Physical Requirements, or other factors:

• Ability to communicate efficiently, and effectively in a collaborative manner.

• Experience with Electronic Medical Record systems

• Proficient in Microsoft Office Suite Programs (Word, Excel, Power Point at a minimum)

• General understanding of behavioral patterns and attitudes common in varying degrees with aging population served and staff.

• Ability to deal patiently and fairly with staff, participants and others.

• Ability to maintain effective working relationships and present and support an atmosphere of teamwork

• Work involves a broad range of problems, many of a complex nature – must be able to work independently, make sound judgments based on assessment and data available and to act accordingly; must be flexible, innovative, and possess good interpersonal skills; must be able to prioritize multiple functions and/or tasks

Immunizations: Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact

Ages of Patients Rendered Care: Adult & Geriatric

Key Responsibilities: (*denotes an age-related skill or task)

• Supports and assists with the creation and maintenance of the PACE Audit Universe Data Sets, which are required by CMS regulations.

• Assists the Center Managers to ensure the Senior TLC Service Delivery, Appeals, and Grievances (SDAG) process meets regulatory requirements. Advises IDT on regulatory requirements of the SDAG process.

• Assists participants in filing appeals of denied service requests, including verifying proper communication of appeal rights to participants/caregivers. Facilitates both internal and external third party appeals of denied service requests.

• Supervises the Quality Support Staff, ensuring (s)he completes assigned tasks as determined by the Quality Coordinator or Leadership team(s).

• Conducts an annual review of the Quality Improvement (QI) program for STLC and updates plan as appropriate, for presentation to Quality Committee, Leadership Team and the STLC Board of Directors. Communicates applicable policies and procedures to appropriate staff and STLC Board of Directors.

• Oversees and coordinates the development and implementation of program wide and center specific quality indicators. Plans and oversees education for STLC staff on QI activities and techniques. Assists in performing the appropriate statistical analysis to ensure consistency and ease of presentation and review to detect trends, patterns, and opportunities for improvements as well as potential problems.

• Coordinates and participates with national and state initiatives in PACE quality management initiatives.

• Oversees data management for QI activities including coordination of collection, entry, analysis and assessment of data. Responsible for ensuring that the statistical data collected and reported is accurate, timely and complete. Oversees submission of data into appropriate data submission program (i.e. HPMS)

• Facilitates review for clinical and non-clinical staff to identify outcomes identified through quality improvement projects to determine if corrective steps improved outcomes.

• Facilitates Corrective Action Plans (CAPs) as directed by the Medical Director and/or Leadership Team when opportunities for improvement are identified. Process includes identification of global problems, development of improvement plans, and implementation of plans to then evaluate their effectiveness. Conducts contracted providers visits in collaboration with the Director of Finance and Administration. Facilitates CAPs from contract provider visits with input from Center Managers and (insert role).

• Documents Quality Improvement Projects generated by the Quality Committee for reporting to the STLC Leadership Team and Board of Directors.

• Participates in priority setting with the Leadership Team, in consultation with staff and participants, and determines priorities for performance improvement at least annually. Immediately communicates problems that are found to threaten the immediate health and safety of participants or staff to the Senior TLC Executive Director and Medical Director to facilitate, along with the IDT, the development of any required corrective plans within 24-hours.

• Collections level II data and creates level II summary and RCA reports.

• Orients Staff and Contract Providers to Senior TLC’s Quality Program. Assists in interface between consumers and program management for quality related complaints. Ensures compliance with Federal, State, and Local laws and regulations.

• Additional duties as assigned by the Medical Director, Program Director, Director of Operations, Director of Quality & Corporate Compliance, or Quality and Compliance Manager.