Manager of Quality and Compliance

Swope Health PACE KC
Kansas City, MO
Category Healthcare
Job Description
The PACE Quality and Compliance Manager leads the development, coordination, implementation, and oversight of PACE KC's Quality Improvement program. This role develops the annual Quality Plan and guides its execution, oversees the review and resolution of grievances and appeals, and directs the Corrective Action Plan process for annual State and CMS audits to maintain regulatory compliance.

Requirements

  • Manage all required quarterly and annual reporting to CMS, the State Administering Agency, and the PACE team
  • Conduct root cause and impact analyses as needed or at the request of CMS or the SAA
  • Audit charts to ensure compliance with CMS and SAA regulations
  • Analyze risk management and quality improvement data to identify and address instances of fraud, waste, and abuse
  • Oversee the evaluation and resolution of medical and non-medical grievances and appeals submitted by participants or their representatives
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