Quality & Compliance Specialist

San Diego’s St. Paul's PACE program (Program of All-Inclusive Care for the Elderly). This innovative program is for individuals 55 years or older, who are living with chronic illness, or disabilities and need coordinated medical care to continue living as independently as possible in their home and community. The healthcare teams at St. Paul’s PACE provide a hands-on approach coordinating medical, social, and home care services so individuals no longer need to manage their medical care alone.


This is a Temporary Full-time position with an anticipated duration of 4 months, with the possibility of extension. The typical schedule for the position is Monday - Friday, 8:00AM - 4:30PM.
Job Summary: Under the direction of the Quality and Compliance Manger, the Quality and Compliance Specialist is responsible for ensuring that the healthcare organization meets all regulatory and accreditation standards. This role involves developing, implementing, auditing and monitoring quality improvement initiatives, as well as ensuring compliance with local, state, and federal regulations. The specialist will work closely with clinical and administrative staff to promote a culture of safety, quality, and compliance. Quality and Compliance specialists play a vital role in assisting with the implementation of the Quality Assessment and Performance Improvement Plan (QAPI) for the St. Paul’s PACE program.
Duties and Responsibilities:
• Assures full implementation of the annual QAPI Plan, performs contract facility
quality assurance audits to ensure quality participant care, collaborate with clinical
staff to develop and implement evidence-based practices
• Lead quality improvement initiatives aimed at enhancing patient care and safety and analyze data to identify trends and areas for improvement, and recommend
corrective actions.
• Conduct regular audits and assessments to ensure compliance with healthcare
regulations, including HIPAA, OSHA, CMS, and specific state regulations.
• Develop and implement policies and procedures to address compliance issues, with a focus on adherence to state-specific healthcare regulations.
• Monitor and ensure compliance with state licensing requirements, including timely renewals and adherence to operational standards mandated by the state.
• Conduct risk assessments to identify potential areas of non-compliance with state
regulations and work with departments to develop mitigation strategies.
• Provide training to staff on compliance and quality standards, including new
regulations and best practices.
• Develop educational materials and conduct workshops or seminars to
promote a culture of quality and compliance.
• Ensures staff integration into the QAPI process through Continuous Quality
Improvement education and developing opportunities for input.
• Manage the grievance and incident reporting process, including investigating and
documenting case details, and ensuring appropriate corrective actions are taken.
• Maintain detailed records of compliance activities, audit results, and quality
improvement initiatives.
• Participates in quality assurance-related communication between contract facilities and St. Paul’s PACE Interdisciplinary Teams.
• Other duties as assigned
Qualifications and Requirements:
Education: Bachelor’s degree in Healthcare Administration, Nursing,
or a related field. Certified Professional in Healthcare Quality (CPHQ)
or Certified in Healthcare Compliance (CHC) is preferred.

Experience: Must have a minimum of one year’s experience working with
the frail or elderly. Proven experience in healthcare auditing or quality
assurance/improvement. One to three years or more years of relevant
compliance experience and/or quality improvement is required; experience
in health-care or aging services compliance highly desirable. Experience in
a clinical setting is a plus.
Skills and Knowledge:
• Strong knowledge of healthcare regulations and accreditation standards.
• Excellent written and verbal communication, with specific ability to maintain
accurate records.
• Effective in project management/ LEAN Process Improvement
• Ability to manage multiple projects and meet deadlines
• Strong ability in auditing and monitoring
• Effective data collection and analysis skills/knowledge of basic statistical
principles
• Excellent analytical and problem-solving skills
• Strong communication and interpersonal skills
• Maintains the confidentiality of all company procedures, results, and
information about residents and participants, clients or families
• Maintains courteous, helpful and professional behavior on the job
Physical Demands and Working Conditions:
• Visual, Hearing and Communication Requirements: Req