TriHealth
Sr. Administrator Compliance, Privacy & Quality Improvement - PACE
TriHealth, Cincinnati, Ohio, United States, 45208
Overview
Sr. Administrator Compliance, Privacy & Quality Improvement - PACE
role at TriHealth. This position oversees the PACE of Cincinnati Compliance & Privacy (C&P) and Quality Improvement (QI) Program. It reports directly to the PACE Board of Directors and administratively to the PACE Senior Director, with a dotted-line reporting relationship to the PACE Medical Director and the TriHealth VP Chief Compliance, Privacy & Audit Officer. The Sr. Administrator shall not serve in operational areas. Key responsibilities include development, annual review and update of the PACE QI plan; creation, implementation and day-to-day operation of an effective C&P Program; program-wide and center-specific C&P and QI indicators; data management; staff 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 needed to address risks, and to develop and manage annual C&P and QI budgets. 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 at least annually to participants, staff, contractors, leadership, and the Board. Ensures QI Plan and C&P Program are integrated into PACE operations; develops action plans and monitoring schedules; monitors implementation; analyzes and reports adherence to leadership and the Board. Maintains up-to-date CMS and Ohio Department of Aging regulatory knowledge; develops and maintains C&P and Quality policies and procedures; educates PACE staff, contractors and agents appropriately. Oversees C&P Program and QI initiatives; assists leadership and the IDT with QI performance improvement initiatives and C&P action plans; ensures timely resolution. Leads CMS and other federal/state regulatory audits, site visits and inspections preparation and response in accordance with TriHealth protocol. Ensures reporting channels for anonymous noncompliance reporting and provides quarterly QI Plan progress with metrics to the Board, including audit results and investigation outcomes. Ensures compliance with CMS and Ohio PACE quality data, monitoring, and reporting; including quarterly HPMS quality indicators. Coordinates response, investigation and corrective actions for any C&P noncompliance; reports findings to leadership and relevant state/federal entities as applicable. Performs medical record reviews to monitor service quality and regulatory compliance; collaborates with medical records staff to ensure proper documentation retention. Oversees grievance evaluation and resolution, incorporating trends into QI initiatives and the QI Plan. Coordinates internal and external appeal processes; incorporates appeal trends into QI initiatives. Develops and tracks C&P & QI in-service training at onset of employment and annually thereafter; maintains documentation per TriHealth policy. Performs annual risk assessments and develops Board-approved annual work plans to monitor compliance status. Qualifications
Bachelor's Degree in Health Care Administration or a related field is required. Master’s Degree in a relevant field is preferred. 5–7 years of experience in healthcare compliance and/or quality improvement is required. Job Requirements: CPHQ certification preferred. Working Conditions
Bending: Rarely Climbing: Rarely Concentrating: Frequently Continuous Learning: Consistently Hearing (Conversation/Other sounds): Frequently Interpersonal Communication: Frequently Kneeling: Rarely Lifting: Varied (under 50 lbs typically) Pulling/Pushing/Reaching/Reading/Looking: Various Sitting/Standing: Frequently Thinking/Reasoning: Consistently Use of hands, Color vision, Visual acuity: Frequent Walking: Frequently Company Values
TriHealth SERVE Standards and ALWAYS Behaviors: Serve, Excel, Respect, Value, Engage. Includes expected behaviors such as welcoming patients, resolving service breakdowns, respecting differences, valuing others’ time, and showing courtesy. Seniority level
Executive Employment type
Full-time Job function
Information Technology Industries
Hospitals and Health Care
#J-18808-Ljbffr
Sr. Administrator Compliance, Privacy & Quality Improvement - PACE
role at TriHealth. This position oversees the PACE of Cincinnati Compliance & Privacy (C&P) and Quality Improvement (QI) Program. It reports directly to the PACE Board of Directors and administratively to the PACE Senior Director, with a dotted-line reporting relationship to the PACE Medical Director and the TriHealth VP Chief Compliance, Privacy & Audit Officer. The Sr. Administrator shall not serve in operational areas. Key responsibilities include development, annual review and update of the PACE QI plan; creation, implementation and day-to-day operation of an effective C&P Program; program-wide and center-specific C&P and QI indicators; data management; staff 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 needed to address risks, and to develop and manage annual C&P and QI budgets. 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 at least annually to participants, staff, contractors, leadership, and the Board. Ensures QI Plan and C&P Program are integrated into PACE operations; develops action plans and monitoring schedules; monitors implementation; analyzes and reports adherence to leadership and the Board. Maintains up-to-date CMS and Ohio Department of Aging regulatory knowledge; develops and maintains C&P and Quality policies and procedures; educates PACE staff, contractors and agents appropriately. Oversees C&P Program and QI initiatives; assists leadership and the IDT with QI performance improvement initiatives and C&P action plans; ensures timely resolution. Leads CMS and other federal/state regulatory audits, site visits and inspections preparation and response in accordance with TriHealth protocol. Ensures reporting channels for anonymous noncompliance reporting and provides quarterly QI Plan progress with metrics to the Board, including audit results and investigation outcomes. Ensures compliance with CMS and Ohio PACE quality data, monitoring, and reporting; including quarterly HPMS quality indicators. Coordinates response, investigation and corrective actions for any C&P noncompliance; reports findings to leadership and relevant state/federal entities as applicable. Performs medical record reviews to monitor service quality and regulatory compliance; collaborates with medical records staff to ensure proper documentation retention. Oversees grievance evaluation and resolution, incorporating trends into QI initiatives and the QI Plan. Coordinates internal and external appeal processes; incorporates appeal trends into QI initiatives. Develops and tracks C&P & QI in-service training at onset of employment and annually thereafter; maintains documentation per TriHealth policy. Performs annual risk assessments and develops Board-approved annual work plans to monitor compliance status. Qualifications
Bachelor's Degree in Health Care Administration or a related field is required. Master’s Degree in a relevant field is preferred. 5–7 years of experience in healthcare compliance and/or quality improvement is required. Job Requirements: CPHQ certification preferred. Working Conditions
Bending: Rarely Climbing: Rarely Concentrating: Frequently Continuous Learning: Consistently Hearing (Conversation/Other sounds): Frequently Interpersonal Communication: Frequently Kneeling: Rarely Lifting: Varied (under 50 lbs typically) Pulling/Pushing/Reaching/Reading/Looking: Various Sitting/Standing: Frequently Thinking/Reasoning: Consistently Use of hands, Color vision, Visual acuity: Frequent Walking: Frequently Company Values
TriHealth SERVE Standards and ALWAYS Behaviors: Serve, Excel, Respect, Value, Engage. Includes expected behaviors such as welcoming patients, resolving service breakdowns, respecting differences, valuing others’ time, and showing courtesy. Seniority level
Executive Employment type
Full-time Job function
Information Technology Industries
Hospitals and Health Care
#J-18808-Ljbffr