PACE Quality Improvement and Compliance Manager

Company: Mount Sinai Medical Center Miami Beach
Location: Hialeah
Posted on: January 21, 2023

Job Description:

PACE Quality Improvement and Compliance Manager
As Mount Sinai grows, so does our legacy of caringLocated in the heart of Miami Beach, overlooking the breathtaking intracoastal waterway, Mount Sinai Medical Center is dedicated to providing exceptional health care to our diverse community enhanced through innovation, technology, teaching, and research.Mount Sinai is South Florida's largest private independent not-for-profit hospital with 672 beds, and a tight-knit community of more than 4,000 employees.
We provide world-class care:

• Named one of America's 250 Best Hospitals for 2020 and 2021 by Healthgrades, positioning Mount Sinai among the top 5% of hospitals in the nation for overall clinical excellence.
• A pioneer in innovative medical research in areas such as cardiology, cancer, memory disorders and pulmonary diseases
• The BEST cardiac surgery survival rate in Florida
• A new seven-story Surgical Tower with 154 all-private rooms and patient centered technology promotes an exceptional patient experience
  Position Responsibilities:
  • In collaboration with the Medical Director and Executive Director, develops and guides the implementation of the annual QI Plan and Corporate Compliance Pan including the Fraud Waste and Abuse initiatives. This position is responsible for planning all required meetings, oversight of all audits and required data collection activities and ensuring Eldercare stakeholders are apprised of QI and Compliance activity and progress.
  • Lead survey preparation projects and is the liaison for Eldercare during all surveys.
  • Works with hospital departments to ensure the Comprehensive Emergency Management Plan, Biomedical Waste Plan and CLIA policies/plans are current at all times.
  • Communicate the QI and Compliance plan to participants, staff, contractors, administration, participant advisory committee and the Board and submit the annual QI Plan to appropriate state and federal agencies.
  • Ensure staff (direct hire and contracted) are engaged in the QI and Compliance process through Continuous Quality Improvement and Compliance education and developing opportunities for input.
  • Develop, monitor, and report on Eldercare Health Plan Management System (HPMS) quality indicators. Prepare presentation of quality improvement for quarterly Quality meetings.
  • Complete audits on medical record documentation, medical and pharmacy claims and other reports to ensure requirements are met and that records and data of all types are maintained per policies and procedures and are retained for the state and federal mandated period.
  • Has oversight of the process to evaluate and resolve medical and non-medical grievances, service delivery requests and appeals by participants and or their representatives to ensure all required timelines are met and ensure information is reviewed for incorporation in the development of Quality Improvement initiatives and annual QI plan.
  • Attend quarterly participant advisory committee meetings and staff meetings to report on QI activities.
  • Assist senior staff and mid level managers with establishing process evaluation and performance improvement initiatives using PDCA (Plan, Do, Study, Act) in their area of responsibility. Help staff identify problems and facilitate problem resolution efforts.
  • Maintain and update as needed the Eldercare FWA program
  • Responds to reports of potential instances of FWA in Eldercare Prescription Drug Plan, including coordinating investigations and developing an action plan.
  • Coordinate internal audits and corrective action plans in collaboration with administrative staff.
  • Oversee employee and contractors credentialing and ensure ongoing compliance with regulation
  • Participate in formulation and maintenance of Eldercare policies and procedures.
  • Know and adhere to the philosophy and goals of Eldercare.
    Qualifications:
    • LPN, RN, MSW, PT or OT BLS or CPR
    • BS in Nursing, Masters Level Social Worker, Physical or Occupational Therapist
    • At least 2 years in a similar role and a minimum of 1 year working with a frail or elderly population.
      Benefits:We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:
      • Health benefits
      • Life insurance
      • Long-term disability coverage
      • Healthcare spending accounts
      • Retirement plan
      • Paid time off
      • Tuition reimbursement
      • Employee assistance program
      • Wellness program
      • On-site housing for selected positions and more!

Keywords: Mount Sinai Medical Center Miami Beach, Hialeah , PACE Quality Improvement and Compliance Manager, Executive , Hialeah, Florida