PACE Quality Analyst III

Position Summary:Under the direct supervision of the PACE Quality Manager, the QAPI Analyst III is dedicated to assessing and decreasing risks associated with participant incidents as well as resolving grievances, appeals and improving participant experience through the investigation of their complaints, concerns and other feedback received. Helps develop, implement, and evaluate activities related to improve PACE participant satisfaction and adheres to the CMS quality reporting measures.Essential Functions of the Job:Responsible for areas related to risk reduction including but not limited to participant incidents, complaints, grievances, and experiences.Acts as a liaison between participants/designated representatives and staff to coordinate and participate in the resolution of complaints, grievances and appeals based on knowledge of the PACE Program’s policies and procedures.Promotes QAPI efforts to reduce incidents and follow through with appropriate staff for support, training, and intervention evaluation.Acts as the primary investigator and contact person for participant grievances, appeals and incidents. Conducts non-biased, accurate, timely, and comprehensive investigation through root-cause analysis (RCA) of all facts related to the grievance/appeal in order to submit a written response and provide feedback to involved staff.Tracks and analyzes participant grievances and incident reports submitted by staff and stakeholders in order to identify potential participant-related risks and areas of future QAPI efforts.Ensures there is a root cause analysis of the complaints, grievances/appeals, recommending for action those measures that are necessary to improve/remove causes of complaints and reduce potential risk associated with the complaints.Investigates and conducts RCA of all incidents that meet the criteria based on CMS guidelines and completes submission of these incidents in the Health Plan Management System (HPMS). Additionally, also submits all medication errors in HPMS.Investigates and works with the related team to ensure corrective action on all incident reports submitted.Maintains and updates all appropriate logs/universes. Maintains and files all relevant documents.Along with the Quality Manager, conducts periodic and annual trainings for staff on grievance and appeals procedures as well as incident reporting procedures.Along with the Director of Quality and Compliance, conducts regular trainings for service requests and other relevant trainings. Conducts detailed service request trainings for relevant new IDT members.Participates on each CMS/DHCS call to help answer HPMS submission related questions.In collaboration with the management team, develops a strategic plan to improve the participant experience through site visits, personal coaching and staff training to ensure service excellence delivery for staff at all levels of the PACE Program.Provides support with respect to participant satisfaction and relations/experience initiatives including the following:Meeting at sites that have identified areas of improvement.Attendance at site meetings as necessary including all staff meetings and QAPI meetings.Provides support through implementation and identification of ways to improve patient experience, streamline work processes, utilize resources more efficiently and reduce potential risk.Proactively identifies, monitors, and summarizes participant satisfaction/complaint trends and reports to the management team on a monthly/quarterly basis.Participates in case specific meetings when addressing incidents related to possible participant involuntary disenrollment or voluntary disenrollments due to participant being unhappy with PACE services.Provides support in the development, design, and modification of SD PACE’s policies and procedures.Role models excellent interpersonal, mediation, conflict management, communication, and problem-solving skills.Additional Duties and Responsibilities:Communicates effectively with participants, co-workers, and supervisors.Enhance professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.Exemplify excellent customer service with patients, visitors, and other employees.Performs other duties as assigned.Works effectively in a team setting.Adheres to SYHealth and SD PACE attendance and punctuality policies and practices.Maintains all records and documentation as required ensuring participant privacy and confidentiality.Job Requirements:Education Required:Master’s degree in a health-related field, business administration, human resources management or related field.In lieu of degree, work experience of 3 years or more as a PACE QAPI Analyst II and High school diploma are acceptable.Certifications/Licenses Preferred:Customer service background or certificate. Experience in dealing with medically underserved and culturally diverse populations preferred.CA valid driver’s license and reliable transportation.Proof of current vehicle insurance (if applicable).Experience Required:Three years or more experience in healthcare, customer service or closely related field; familiarity with outpatient care environment and quality improvement processes; ability to handle multiple tasks in a fast-paced environment; strong organizational and planning skills; conflict resolution skills; demonstrated problem solving skills; and good judgment. Work experience in PACE Quality.Verbal and written skills required to perform the job:Excellent oral and written communication skills required; active listening ability and knowledge of adult learning modes required to train, facilitate, and motivate various staff in customer service and patient relations quality improvement activities.Technical Knowledge and Skills Required to Perform the Job:Proficient in Microsoft Office (Word, Excel, and Access) to write letter to participants and present data in easily understood formats; computer-literate to learn and operate practice management specific applications.Networked personal desktop, laptop computer, tablet, or other hand-held device, document center and telephone.Working Conditions and Physical Requirements:Prolonged periods of sitting and standing; driving within the county to travel between clinic locations and to occasional community partner meetings. May be required to work evenings and/or weekends.Universal Requirements:Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.About Us:

San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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