Quality and Regulatory Specialist
Job Description
Job Description
Description:
Description
PACE of Southwest Michigan is currently seeking a full-time, Quality and Regulatory Specialist to join our Quality team.
The Quality and Regulatory Specialist provides guidance in all aspects of the participant centered regulations , which includes all PACE Services and Participant Rights processes to enhance the quality of care and ensure compliance with state and federal regulations. This role is responsible for providing regulatory guidance to the members of the team. This role is onsite at the St. Joseph location.
If you have a strong understanding of compliance regulations, attention to detail, and the ability to stay ahead of evolving legal landscapes, we encourage you to apply.
Who is PACE of Southwest Michigan?
PACE (Program of All-Inclusive Care for the Elderly) of Southwest Michigan is a vibrant and compassionate healthcare program designed to empower seniors to live their best lives, safely and independently, in the comfort of their own homes. Since its founding in 2012, PACE has been transforming the way older adults experience care by offering a comprehensive range of services—everything from medical and home care to engaging day center activities, rehabilitation, transportation, and caregiver support. With a dedicated team of professionals, PACE tailors care to meet the unique needs of each participant, ensuring they receive personalized attention and holistic support. Serving Berrien County and parts of Cass and Van Buren Counties, PACE of Southwest Michigan is not just a program, but a community that's helping seniors thrive, stay connected, and live with dignity.
Why Join PACE of Southwest Michigan?
In addition to our mission-driven culture and commitment to serving the participants within our community, we also provide: · Paid Time Off (PTO) and paid holidays · Employer-provided life, short-term disability, and long-term disability insurance · 403b retirement plan · Education and training reimbursement · Voluntary life insurance and more!Job Summary
Specifications
Education: Associates degree required; Bachelors in Business Management, Organizational Communication, Health Administration and/or equivalent education/experience in healthcare related field preferred.
Experience: One (1) year experience in a PACE organization preferred. Experience within a Quality and or Regulatory environment required.
Special Training: Only acts within scope of practice. Meet a standardized set of orientation and/or individual competencies for the specific position description established by PACE of Southwest Michigan and approved by CMS before working independently.
Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.
Specific Requirements and Considerations: May be subject to exposure and handling of infectious waste, diseases, conditions, or hazardous chemicals, etc., including potential exposure to TB, AIDS, and/or Hepatitis B.
Key Responsibilities
- Ensures Service Delivery Requests, Grievance, and Appeals documentation satisfies federal and state regulatory requirements for PACE
- Audits procedures and operational processes regarding participant services
- Coordinates responses from department audits for submission to leadership
- Coordinates the grievance process including tracking, processing, data analysis, assisting leaders with resolution and reporting
- Manages the entire appeals process, ensuring all regulatory compliance
- Supports in the investigations and resolution of quality-of-care concerns, complaints, grievances, and appeals
- Promotes prompt, effective, and caring solutions for all concerned parties
- Provides monthly reports on Service Delivery, Appeals, Grievances, Care Plan updates and Care Plan compliance
- Assists in preparation for internal and external site audits and regulatory activities
- Provides mandatory documentation/regulatory training as assigned
- Completes special projects and other duties as assigned
- Performs other duties as assigned
- Abides by all established PACE of Southwest Michigan policies, rules, and regulations
Skills and Knowledge
- Exceptional attention to detail
- Strong organizational skills and ability to manage multiple projects simultaneously
- Excellent verbal and written communication skills
- Computer proficiency
- Microsoft Office Suite proficiency
- Strong analytical and problem-solving skills
- Ability to work a flexible work schedule
- Ability to work well with all employees/vendors including Interdisciplinary Team
- Must have working knowledge of clinical terminology and healthcare operation
- Ability to meet deadlines both individually and in a collaborative team environment
- Ability to establish and meet goals
- High level of autonomy is required
- Possess strong interpersonal skills
PM20
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to sit and use hands and fingers, handle or feel objects, tools or controls. The employee is occasionally required to stand and walk. The employee must be able to travel in all kinds of weather.
While performing the duties of this job, the employee is required to frequently move up to 50 pounds and perform physical demands expected while providing medical care for an elderly population. Specific vision abilities required by this job include close vision, distance vision and the ability to focus.
Every effort has been made to identify the essential functions of this position. However, this in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.
Please be aware that we require employees to pass a background check and drug screen. PACE of SWMI is a non-smoking facility.
Requirements:
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