GENERAL DESCRIPTION:

Under the supervision of the Medical Director, the Quality Improvement Manager is responsible for formulating methodologies to support all departments in the collection and measurement of data appropriate for determining Bienvivir Senior Health Services outcomes, developing all aspects of internal and external quality and performance improvement programs and risk reduction, and assisting departments with corrective action plans that support improvement activities. The Quality Improvement Manager will work collaboratively with employees, contractors, and participants to plan and implement initiatives that support improved organizational and participant outcomes.

RESPONSIBILITIES:

1. Oversees the Quality Improvement department. Identifies and develops the processes for the collection of outcomes data. Analyzes information and develops reports that substantiates the program successes in areas that benefit participant outcomes.

2. Develops, and implements the Quality Improvement plan. Conducts annual reviews and updates of the Quality Improvement Plan. Conducts meetings and disseminates information to staff and contracted providers on the Quality Improvement plan. Ensures that the Quality Improvement plan is presented to the BSHS Board of directors on at least an annual basis.

3. Assists departments, identified in the Quality Improvement plan, in identifying performance goals and in developing processes to evaluate their performance and outcome measures.

4. Submits PACE Quality Data elements via the Health Plan Management System (HPMS) in compliance with requirements and time frames set forth by CMS.

5. Coordinates meetings with CMS account manager as needed to review PACE Quality Data elements submitted to CMS.

6. Reviews and oversees internal investigations of grievances to identify and eliminate risk trends that affect quality and safety.

7. Reviews all appeals to identify and eliminate risk trends that affect quality and safety.

8. Reviews all unusual incidents to identify and eliminate risk trends that affect quality and safety.

9. Reviews and oversees internal investigations and root cause analysis of PACE Quality Data Elements that resulted in adverse participant outcome as define by CMS. The investigations will assesses compliance with BSHS policies, procedures, and CMS regulations as related to the occurrence and will identify findings and improvement opportunities.

10. Responsible for the data collection and trend analysis on all data collected as it pertains to outcome development and risk reduction.

11. Communicates with department managers, supervisors, contractors, and contract physicians to review identified risk trends that affect quality and safety. Assists in formulating improvement plans for identified risk trends.

12. Responsible for the coordination of the annual participant and caregiver satisfaction surveys and the annual HOS-M survey.

13. Assist the Infection Control Committee Chair with evaluating and trending of infection control data for performance improvement activities.

14. Develops and conducts in-service trainings both internally and externally for employees and contractors as needed.

15. Organizes presentations for Quality Improvement Committee, Committee with Community Input, Grievance and Appeals Committee, Supervisor’s, and General Staff meetings to provide Quality Improvement information and provide guidance related to Quality Improvement.

16. Supervises the Quality Improvement Clerk, Quality Improvement Data Analyst and the Quality Improvement RN. Monitors their performance, provides leadership, guidance and assistance.

17. Maintains regulatory and compliance requirements for the PACE organization

18. Assist with the collection and submission of data (Universes) requirements by CMS for the PACE organization audit via HPMS in compliance with requirements and time frames set forth by CMS.

19. Responsible for other tasks as assigned.

Required Skills

QUALIFICATIONS / REQUIREMENTS:

1. Graduate of an Accredited Nursing Program with a license to practice in the State of Texas as a Registered Nurse (RN) with a minimum of 3 years clinical experience or Bachelor’s degree from an accredited Healthcare Administration or a related Healthcare Management degree with a minimum of 3 years experience.

2. Previous experience in implementing quality programs is (desired).

3. Prior experience in use of Excel for creating and maintaining databases. Knowledge in the collection, measurement, trending, reconciliation, and analysis of data.

4. Understanding of Six Sigma methodology (preferred).

5. Bilingual verbal and written communications (English/Spanish desired).

Required Experience

QUALIFICATIONS / REQUIREMENTS:

1. Graduate of an Accredited Nursing Program with a license to practice in the State of Texas as a Registered Nurse (RN) with a minimum of 3 years clinical experience or Bachelor’s degree from an accredited Healthcare Administration or a related Healthcare Management degree with a minimum of 3 years experience.

2. Previous experience in implementing quality programs is (desired).

3. Prior experience in use of Excel for creating and maintaining databases. Knowledge in the collection, measurement, trending, reconciliation, and analysis of data.

4. Understanding of Six Sigma methodology (preferred).

5. Bilingual verbal and written communications (English/Spanish desired).