TriHealth
Sr. Administrator Compliance, Privacy & Quality Improvement - PACE
TriHealth, Norwood, Ohio, United States
Overview
PACE Compliance, Privacy & Quality Improvement Sr. Administrator oversees the PACE of Cincinnati Compliance & Privacy (C&P) and Quality Improvement (QI) Program. The role reports directly to the PACE Board of Directors (the Board) and administratively to the PACE Senior Director. It maintains a dotted-line reporting relationship with the PACE Medical Director and the TriHealth VP Chief Compliance, Privacy & Audit Officer. The Sr. Administrator shall not serve in operational areas. Oversight responsibilities include the creation, annual review and update of the PACE QI plan, and development, implementation, and day-to-day operations of an effective C&P Program. This role will develop and implement program-wide and PACE center-specific C&P and QI indicators, data management, program staff, C&P and QI education and training, preparation of quality reports, and coordination of program-wide process improvement or corrective action arising from monitoring, auditing and/or investigatory activities. The Sr. Administrator participates as a contributing member of the PACE of Cincinnati leadership team and identifies resources and strategies necessary to address risks and develops and manages annual C&P and QI budgets. Job Requirements
Bachelor's Degree in a relevant field such as Health Care Administration, or Bachelor\u2019s of Science (Required) Master\u2019s Degree in a relevant field (Preferred) 5 - 7 years experience working in healthcare compliance and/or quality improvement (Required) Other CPHQ certification (Preferred) Job Responsibilities
Develops and implements the annual PACE of Cincinnati QI Plan and quality indicators in collaboration with the PACE Medical Director. Reviews, revises, and communicates the QI Plan no less than annually to participants, staff, contractors, leadership, and the Board. Ensures QI Plan and C&P Program are integrated into PACE Program operations, developing action plans and monitoring schedules for required periodic initiatives; monitors implementation; and analyzes and reports adherence to leadership and the Board. Maintains up-to-date CMS and Ohio Department of Aging regulatory knowledge by keeping apprised of CMS guidance materials, develops, maintains and makes readily available C&P and Quality policies and procedures and educates PACE staff and agents/contractors appropriately. Oversees C&P Program and QI initiatives; assists leadership and the IDT with establishing QI performance improvement initiatives and C&P action plans and ensures appropriate and timely resolution. Leads CMS and other federal and state regulatory body audits, site visits and inspections preparation and response in accordance with TriHealth protocol. Ensures that employees, contractors, patients, and/or their caregivers have the ability to report noncompliance anonymously in accordance with TriHealth Compliance & Privacy Program protocol. Prepares no less than quarterly QI Plan progress with quality indicator metrics and C&P Program updates to the Board, including results of auditing and monitoring activities and investigation of noncompliance in accordance with TriHealth Compliance & Privacy Program protocol. Ensures compliance with CMS & Ohio State PACE quality data, monitoring, and reporting, including quarterly reporting on PACE HPMS quality indicators. Ensures response, investigation, and appropriate corrective action and resolution of any potential or actual instances of C&P noncompliance, including reporting instances of fraud or other misconduct to the appropriate authorities and entities in alignment with TriHealth Compliance & Privacy Program protocol. Conducts medical record chart reviews to monitor the quality of services provided to PACE participants and ensure federal and state regulatory compliance; works with medical records staff to ensure all documentation requirements are met and records retained per TriHealth policy. Oversees evaluating and resolving medical and non-medical grievances by participants and/or their representatives; ensures grievance information and trends are reviewed. Incorporates grievance trends in QI initiatives and the QI plan. Coordinates internal and external appeal process; ensures information is reviewed to incorporate appeals trends in developing QI initiatives and the QI plan. Develops, implements and tracks completion of C&P & QI in-service training materials at onset of employment and annually thereafter to meet regulatory requirements and organizational needs; maintains documentation of C&P and QI program in accordance with TriHealth document retention and destruction policy. Conducts annual Risk Assessments, ranks identified risks and creates Board-approved annual Work Plans to assess status of compliance for identified risks. In accordance with TriHealth Compliance & Privacy program and policy, ensures that all PACE team members, providers, associates, agents and vendors are screened against OIG, SAM and applicable State Exclusions lists as well as CMS Preclusion & Medicare opt-out lists, state nurse aide registry and other state licensure lists. Individuals or entities that are Excluded or have any other status that does not meet TriHealth standard will be investigated in accordance with protocol with confirmed noncompliance resolved. Reports findings to leadership and the Board regarding patients’ and caregivers’ annual satisfaction surveys. Working Conditions
Bending - Rarely Climbing - Rarely Concentrating - Frequently Continuous Learning - Consistently Hearing: Conversation - Frequently Hearing: Other Sounds - Frequently Interpersonal Communication - Frequently Kneeling - Rarely Lifting
Lifting 50+ Lbs. - Rarely Lifting
Pulling - Occasionally Pushing - Occasionally Reaching - Occasionally Reading - Consistently Sitting - Frequently Standing - Frequently Stooping - Rarely Talking - Frequently Thinking/Reasoning - Consistently Use of Hands - Frequently Color Vision - Frequently Visual Acuity: Far - Frequently Visual Acuity: Near - Frequently Walking - Frequently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS... Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS... Recognize and take personal responsibility to address and recover from service breakdowns when a customer\u2019s expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect: ALWAYS... Respect cultural and spiritual differences and honor individual preferences. Respect everyone\u2019s opinion and contribution, regardless of title/role. Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS... Value the time of others by striving to be on time, prepared and actively participating. Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS... Acknowledge wins and frequently thank team members and others for contributions. Show courtesy and compassion with customers, team members and the community
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PACE Compliance, Privacy & Quality Improvement Sr. Administrator oversees the PACE of Cincinnati Compliance & Privacy (C&P) and Quality Improvement (QI) Program. The role reports directly to the PACE Board of Directors (the Board) and administratively to the PACE Senior Director. It maintains a dotted-line reporting relationship with the PACE Medical Director and the TriHealth VP Chief Compliance, Privacy & Audit Officer. The Sr. Administrator shall not serve in operational areas. Oversight responsibilities include the creation, annual review and update of the PACE QI plan, and development, implementation, and day-to-day operations of an effective C&P Program. This role will develop and implement program-wide and PACE center-specific C&P and QI indicators, data management, program staff, C&P and QI education and training, preparation of quality reports, and coordination of program-wide process improvement or corrective action arising from monitoring, auditing and/or investigatory activities. The Sr. Administrator participates as a contributing member of the PACE of Cincinnati leadership team and identifies resources and strategies necessary to address risks and develops and manages annual C&P and QI budgets. Job Requirements
Bachelor's Degree in a relevant field such as Health Care Administration, or Bachelor\u2019s of Science (Required) Master\u2019s Degree in a relevant field (Preferred) 5 - 7 years experience working in healthcare compliance and/or quality improvement (Required) Other CPHQ certification (Preferred) Job Responsibilities
Develops and implements the annual PACE of Cincinnati QI Plan and quality indicators in collaboration with the PACE Medical Director. Reviews, revises, and communicates the QI Plan no less than annually to participants, staff, contractors, leadership, and the Board. Ensures QI Plan and C&P Program are integrated into PACE Program operations, developing action plans and monitoring schedules for required periodic initiatives; monitors implementation; and analyzes and reports adherence to leadership and the Board. Maintains up-to-date CMS and Ohio Department of Aging regulatory knowledge by keeping apprised of CMS guidance materials, develops, maintains and makes readily available C&P and Quality policies and procedures and educates PACE staff and agents/contractors appropriately. Oversees C&P Program and QI initiatives; assists leadership and the IDT with establishing QI performance improvement initiatives and C&P action plans and ensures appropriate and timely resolution. Leads CMS and other federal and state regulatory body audits, site visits and inspections preparation and response in accordance with TriHealth protocol. Ensures that employees, contractors, patients, and/or their caregivers have the ability to report noncompliance anonymously in accordance with TriHealth Compliance & Privacy Program protocol. Prepares no less than quarterly QI Plan progress with quality indicator metrics and C&P Program updates to the Board, including results of auditing and monitoring activities and investigation of noncompliance in accordance with TriHealth Compliance & Privacy Program protocol. Ensures compliance with CMS & Ohio State PACE quality data, monitoring, and reporting, including quarterly reporting on PACE HPMS quality indicators. Ensures response, investigation, and appropriate corrective action and resolution of any potential or actual instances of C&P noncompliance, including reporting instances of fraud or other misconduct to the appropriate authorities and entities in alignment with TriHealth Compliance & Privacy Program protocol. Conducts medical record chart reviews to monitor the quality of services provided to PACE participants and ensure federal and state regulatory compliance; works with medical records staff to ensure all documentation requirements are met and records retained per TriHealth policy. Oversees evaluating and resolving medical and non-medical grievances by participants and/or their representatives; ensures grievance information and trends are reviewed. Incorporates grievance trends in QI initiatives and the QI plan. Coordinates internal and external appeal process; ensures information is reviewed to incorporate appeals trends in developing QI initiatives and the QI plan. Develops, implements and tracks completion of C&P & QI in-service training materials at onset of employment and annually thereafter to meet regulatory requirements and organizational needs; maintains documentation of C&P and QI program in accordance with TriHealth document retention and destruction policy. Conducts annual Risk Assessments, ranks identified risks and creates Board-approved annual Work Plans to assess status of compliance for identified risks. In accordance with TriHealth Compliance & Privacy program and policy, ensures that all PACE team members, providers, associates, agents and vendors are screened against OIG, SAM and applicable State Exclusions lists as well as CMS Preclusion & Medicare opt-out lists, state nurse aide registry and other state licensure lists. Individuals or entities that are Excluded or have any other status that does not meet TriHealth standard will be investigated in accordance with protocol with confirmed noncompliance resolved. Reports findings to leadership and the Board regarding patients’ and caregivers’ annual satisfaction surveys. Working Conditions
Bending - Rarely Climbing - Rarely Concentrating - Frequently Continuous Learning - Consistently Hearing: Conversation - Frequently Hearing: Other Sounds - Frequently Interpersonal Communication - Frequently Kneeling - Rarely Lifting
Lifting 50+ Lbs. - Rarely Lifting
Pulling - Occasionally Pushing - Occasionally Reaching - Occasionally Reading - Consistently Sitting - Frequently Standing - Frequently Stooping - Rarely Talking - Frequently Thinking/Reasoning - Consistently Use of Hands - Frequently Color Vision - Frequently Visual Acuity: Far - Frequently Visual Acuity: Near - Frequently Walking - Frequently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS... Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS... Recognize and take personal responsibility to address and recover from service breakdowns when a customer\u2019s expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect: ALWAYS... Respect cultural and spiritual differences and honor individual preferences. Respect everyone\u2019s opinion and contribution, regardless of title/role. Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS... Value the time of others by striving to be on time, prepared and actively participating. Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS... Acknowledge wins and frequently thank team members and others for contributions. Show courtesy and compassion with customers, team members and the community
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