Senior Quality Improvement Analyst

Description

Who We Are

Are you interested in working for an organization whose mission is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?

Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.

Job Summary

The Senior Quality Improvement (QI) Analyst is responsible for assessing and monitoring the effectiveness of processes and workflows related to the QI Program and Workplan.  The Senior QI Analyst collects, analyzes, and reports QI program performance outcomes, and is responsible for identifying opportunities and utilizing continuous quality improvement tools to facilitate the improvement of QI Initiatives.  This individual will collaborate with Innovative Integrated Health, Inc. (IIH) leaders and departments at all levels to prioritize and drive quality outcomes and improvement throughout the organization.  

Essential Job Functions

Duties include, but are not limited to:

• Develops tools for data collection, validation, analysis and reporting. This includes reports such as immunizations, incidents 

        of infection, utilization management, enrollment data and coding data. 

• Collects and evaluates performance data in key quality areas that include assessments / care planning, service 

        determination requests, departmental quality initiatives, grievances, appeals, and the Department of Health Care Services  

        (DHCS) or the Centers for Medicare & Medicaid Services (CMS) regulatory compliance. Validating, preparing and submitting 

        data into the CMS Health Plan Management System (HPMS). 

• Provides direction and management of quality improvement activities utilizing continuous quality improvement principles 

        and methodologies.  

• Uses data to evaluate the effectiveness of organizational performance improvement activities; identifies trends and tracks 

        issues, recommends actions and facilitates cross-functional teams using Plan-Do-Study-Act (PDSA) model for improvement.

• Assists with the development and implementation of corrective action plans that lead to the fulfillment of quality care goals.

• Assists with PACE reporting requirements that include Level I, Level II reporting, and additional reporting to Federal and 

        State health authorities as required.

• Assist in preparing data for the Annual Participant Surveys. This includes the Health Outcomes Survey-Modified (HOS-M) 

        participation. 

• Assists leadership with the maintenance and annual review/revision of organizational policies and procedures.

• Tracks and coordinates the review of cases to ensure appropriate assignment and completion of case review and protects 

        highly sensitive information contained in the reports.

• Provides organization-wide QI education, in-services, and training, as needed.

• Provides assistance and leads with interpretation of raw data, statistical results or otherwise compiled information; identifies 

        follow-up action items and prepares or assists in the preparation of written reports and/or oral presentation of findings to 

        internal and external audiences, clinical staff, compliance agencies, providers.

• Participates in risk management and assessment activities, identifying and systematically reducing potential risks to the 

        safety of PACE participants and the healthcare environment.

• Oversees the development and maintenance of audit tools based on applicable quality and regulatory audit protocols. 

• Updates audit tools at least on an annual basis to reflect changes to regulatory requirements.

• Conducts audits of delegated entities, summarizes findings, and presents summary of results to Quality Oversight 

        Committee.

• Works with QI Program Manager to follow-up on grievance investigations and assists with managing Root Cause Analysis 

        (RCA) and Corrective Action Plans (CAP), as needed.

• Runs required reports from monitored entities and follows up with necessary departments as needed.

• Supports the Director of QI in developing and conducting an annual internal risk assessment of areas to include in the audit 

        and monitoring plan.

• Serves as knowledge expert for assigned functional areas.

• Facilitates improvem