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Quality Specialist

Company: Pace of Southwest Michigan
Location: Saint Joseph
Posted on: January 23, 2023

Job Description:

Description:
We are seeking an experienced, Full-time Quality Specialist to join our team! Apply today with PACE of Southwest Michigan!We offer a competitive salary and benefit package, that includes medical, dental, 403B, PTO, holidays off (w/pay) and a M-F work schedule. PACE, which stands for Program for All-Inclusive Care for the Elderly, is a unique option for older adults who wish to remain in their home as they age. Our goal is to provide senior community members with the care, medical treatment and support they need to achieve the highest quality of life.We are actively recruiting for a Quality and Regulatory Specialist. This position requires a dynamic individual, who enjoys working in an environment that encourages developing relationships with our team members and participants, where a team focused approach to care is the cornerstone of our organization.Job SummaryThe Quality and Regulatory Specialist provides guidance in all aspects of the participant centered regulations. Including all PACE Services and Participant Rights processes to enhance the quality of care and ensure compliance with state and federal regulations. This role is responsible for providing regulatory guidance to the members of the team. Key Responsibilities

  • Ensures Service Delivery Requests, Grievance, and Appeals documentation satisfies federal and state regulatory requirements for PACE
  • Audits procedures and operational processes regarding participant services
  • Coordinates responses from department audits for submission to leadership
  • Coordinates the grievance process including tracking, processing, data analysis, assisting leaders with resolution and reporting
  • Manages the entire appeals process, ensuring all regulatory compliance
  • Supports in the investigations and resolution of quality-of-care concerns, complaints, grievances, and appeals
  • Promotes prompt, effective, and caring solutions for all concerned parties
  • Provides monthly reports on Service Delivery, Appeals, Grievances, Care Plan updates and Care Plan compliance
  • Assists in preparation for internal and external site audits and regulatory activities
  • Provides mandatory documentation/regulatory training as assigned
  • Completes special projects and other duties as assigned
  • Performs other duties as assigned
  • Abides by all established PACE of Southwest Michigan policies, rules, and regulationsPM20

    Requirements:
    SpecificationsEducation: High School Diploma or equivalent required; Associates degree in Business Management, Organizational Communication, Health Administration and/or equivalent education/experience in healthcare related field preferred.Experience: One (1) year experience in a PACE organization preferred. Experience within a Quality and or Regulatory environment required. Special Training: Only acts within scope of practice. Meet a standardized set of orientation and/or individual competencies for the specific position description established by PACE of Southwest Michigan and approved by CMS before working independently. Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.Specific Requirements and Considerations: May be subject to exposure and handling of infectious waste, diseases, conditions, or hazardous chemicals, etc., including potential exposure to TB, AIDS, and/or Hepatitis B. Skills and Knowledge
    • Exceptional attention to detail
    • Strong organizational skills and ability to manage multiple projects simultaneously
    • Excellent verbal and written communication skills
    • Computer proficiency
    • Microsoft Office Suite proficiency
    • Strong analytical and problem-solving skills
    • Ability to work a flexible work schedule
    • Ability to work well with all employees/vendors including Interdisciplinary Team
    • Must have working knowledge of clinical terminology and healthcare operation
    • Ability to meet deadlines both individually and in a collaborative team environment
    • Ability to establish and meet goals
    • High level of autonomy is required
    • Possess strong interpersonal skillsPhysical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to sit and use hands and fingers, handle or feel objects, tools or controls. The employee is occasionally required to stand and walk. The employee must be able to travel in all kinds of weather.While performing the duties of this job, the employee is required to frequently move up to 50 pounds and perform physical demands expected while providing medical care for an elderly population. Specific vision abilities required by this job include close vision, distance vision and the ability to focus. Every effort has been made to identify the essential functions of this position. However, this in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position. PI201774006

Keywords: Pace of Southwest Michigan, South Bend , Quality Specialist, Other , Saint Joseph, Indiana

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