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Time Type:

Full time

Department:

PACE Administration

All Locations:

300 Ocean Avenue – Revere

Position Summary:

The Clinical Quality Director is a key member of PACE Senior Management and PACE Center Manager/Discipline Manager Team. Responsible for management of PACE Quality Assessment and Performance Improvement Program, including direct supervision of PACE Quality Team. Leveraging a strong foundation in clinical pharmacy, this role integrates regulatory knowledge with patient-centered strategies to drive continuous quality improvement in quality outcomes and risk mitigation.

Clinical Quality director will collaborate with the medical director, clinical operations director, and executive director to plan, organize, direct, and lead the personnel and work processes of the Quality Improvement (QI) and utilization management programs. Ensures regular progress in the ongoing implementation of PACE QI plan by organizing, coordinating, and monitoring deliverables in collaboration with PACE Quality Team. Chairs and/or participates in a number of key QI Committees with a goal of oversight and improvement in critical areas including medication safety, housing, and falls.

In collaboration with PACE Quality Team and Senior Manager for Strategic Initiatives and Analytics, oversees QI and special project meeting schedules, agendas and documentation of activities; coordinates data collection and improvement to data collection tools and processes; synthesizing, analyzing and presenting data to support clinical and administrative performance and decision making.

Coordinates with Compliance Director for meeting reporting requirements of CMS-defined quality indicators in HPMS. Annually updates PACE QI plan for presentation to PACE Senior Management and NeighborHealth Board of Directors if indicated.

Additional roles may include –

Clinical initiative oversight in coordination with Medical Director, Clinical Operations Director, and Executive Director, on clinical initiatives integrating quality and financial sustainability. Coordinating with Data Analysts to target areas of opportunity for savings and growth.

Government Affairs/Advocacy in consultation with the Executive Director and Health Center Government Affairs department to advocate for issues benefitting PACE participants. State and federal engagement required, including work with MassPACE and the National PACE Association.

CLINICAL QUALITY AND PERFORMANCE IMPROVEMENT

• Oversees QI Program in collaboration with the PACE Senior Management Team (Executive Director, CPO, Medical Director, Clinical Director, Operations Director) to ensure that the Program meets regulatory requirements for data integrity, data-driven performance improvement, wide participation in performance improvement activities across the organization, and oversight of policies/ procedures.

• Oversees implementation of QI Plan including:

• • collaborates with QI Leadership Team to monitor compliance trends, key performance metrics, and related projects;

  • Attends meetings, reviews minutes and data reports as needed to monitor progress and identify barriers to implementation of QI Plan.

  • Works with Analyst team to ensure regular updates of dashboards

  • Works with Committee Chairs, Team Leaders and others to design and implement a coordinated approach to oversight of QI implementation that includes regularly scheduled meetings, submission of data and trend reports

• Collaborates with PACE Leadership, and Compliance Director to assist in review of PACE Policies and Procedures to ensure:

• • Consistency across policies and procedures and departments;

  • Compliance with CMS, State and other regulations and requirements;

  • Compliance with NeighborHealth policies and procedures;

  • Collaborate with Clinical Quality Director on policy and procedure approval as required through Medical Standards Committees.

• Monitors implementation of PACE policies and procedure:

• • Maintains directory of policy and procedure audits and schedule for report of audit results;

  • Reviews quarterly audit trend reports.

• Maintains processes for collection of CMS-defined data elements and information for reporting in accordance to CMS requirements using a pharmacy informed lens on safety and compliance.

• Oversees Quality Manager who maintains data submission through HPMS.

• Collaborates with data analyst team on utilization management trend reports to incorporate PACE and other benchmarks as appropriate to improve quality of care.

• In collaboration with QI Leadership Team, conducts annual end of year analysis and update of Quality Assessment and Performance Improvement Plan. Produces end of year report and updated plan for presentation to the PACE senior leadership, and the NeighborHealth Board of Directors when indicated.

• Serves as a subject matter expert on medication management processes, collaborating closely with Pharmacy, Nursing, and Medical Leadership.

• Consults with Government Affairs and provides support for related PACE initiatives.

STAFF AND CLINICAL QUALITY MANAGEMENT & INITIATIVES

• Recruits, hires, and provides direct supervision for Quality Manager.

• Recruits, hires, and provides direct supervision for PACE Member Experience Manager.

• Provides support to the PACE Medical Director to collaboratively oversee protocols for clinic operations, activities related to utilization management, activities related to compliance and prevention of fraud, waste and abuse

• Provides support for Quality Analyst

• Collaborates with PACE Medical Director and Clinical Operations director on clinical initiatives as determined by PACE Senior team.

PACE AND GENERAL REQUIREMENTS: KNOWLEDGE, SKILLS AND ATTITUDES (This section not applicable to initial assessment; all PACE employees and contractors attain these competencies through participation in PACE and JACHO orientation programs)

Demonstrates commitment to PACE mission by actively promoting the autonomy and dignity of PACE program participants.

Demonstrates the ability to communicate effectively and respectfully through verbal and written skills. Documents in accordance with protocol.

Demonstrates knowledge of Participant Rights by

• actively protecting rights to privacy;

• always treating participants with respect;

• encouraging and assisting participants in filing of complaints and grievances;

• helping to maintain and clean and safe environment;

• helping to ensure that restraint and involuntary seclusion are never used as a means of coercion, discipline, punishment, retaliation, or for the convenience of staff and those restraints, when required by extraordinary circumstance, are always applied and monitored in accordance with policy/procedure.

Demonstrates adherence to health and safety codes and concerns by:

• Effectively participating in fire and disaster drills;

• Utilizing proper technique for disposal of biohazard and other waste;

• Immediately cleaning spills, clearing blocked pathways, securing equipment, removing damaged equipment, and otherwise addressing hazards;

• Reporting observations of damaged equipment or environmental hazards to supervisor or Center Director.

• Promotes a sense of “team work” through demonstration of self-direction and self-motivation. Solves problems independently and knows when to seek consultation.

• Participates in the orientation of new staff.

• Demonstrates commitment to performance improvement by actively participating in one or more performance improvement committees or making a minimum of two suggestions for program or other improvements over the course of the year.

OTHER DUTIES & RESPONSIBILITIES (ORGANIZATIONAL COMPETENCIES)

• Reads, understands and complies with all Standards of Conduct, JCAHO policies, CMS Pace Program Regulations and Standards, applicable State regulations and guidelines, PACE policies and procedures and all laws related to position responsibilities and employment at NeighborHealth;

• Adheres to NeighborHealth standards of Employee Conduct and all related policies and procedures by:

• • Demonstrating excellent customer service;

  • Showing respect to other employees;

  • Adhering to standards of cultural competency and non-discrimination;

  • Adhering to standards of privacy;

  • Adhering to attendance and other policies and utilizing appropriate notification and other procedures.

• Upholds procedures and systems to safeguard the confidentiality of all patient and employee information.

• Upholds safety policies, practices, and procedures including safety, fire safety, electrical safety, proper body mechanics and material handling, office/ergonomic safety and other employee safety measures.

• Attends PACE and other required training annually.

• Attends MassPACE and NPA meetings as required.

EEO & Accommodation Statement:

NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@ NeighborHealth.com or call 617-568-4480 to let us know the nature of your request

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According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or “apps.” Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.

E-Verify Program Participation Statement:

NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.