Quality Manager, Jordan Valley Senior Care (JVSC) PACE

Quality Manager

Jordan Valley Community Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple: Improve our community's health through access and relationships. By working collaboratively with partners and continually innovating, JVH strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare.

The Quality Manager, in collaboration with the Jordan Valley Health (JVH) Quality and Compliance department, is responsible for designing, implementing, and sustaining a comprehensive quality improvement (QI) and compliance plan for Jordan Valley Senior Care. This position serves as the program's quality lead, ensuring adherence to federal and state PACE regulations. The Quality Manager collaborates with JVH compliance team to coordinate JVSC internal and external auditing activities, manages federal and state reporting obligations, participates in JVH's Quality and Compliance committee and acts as the primary contact for CMS and the Missouri state Medicaid agency on regulatory and quality matters. The Quality Manager reports directly to the Executive Director and is matrixed with the JVH Compliance Director. This role serves as a liaison between JVSC quality/compliance activities and other JVH programs.

The Quality Manager leads quality improvement and compliance activities for Jordan Valley Senior Care, ensuring adherence to CMS, PACE, federal, and Missouri state requirements. This role oversees audits, corrective action plans, regulatory reporting, quality dashboards, grievance and appeals processes, participant rights protections, fraud/waste/abuse monitoring, and policy updates. The Quality Manager partners closely with clinical, operational, compliance, and executive leadership to identify risks, improve outcomes, support staff training, and maintain regulatory readiness.

• Lead the design, implementation, and ongoing management of the quality improvement program for Jordan Valley Senior Care.
• Ensure compliance with federal and state PACE regulations, CMS requirements, Missouri Medicaid/MO HealthNet guidance, and internal organizational standards.
• Coordinate internal and external audit activities, including CMS/state audits, mock audits, audit tracking, corrective action plans, and post-audit analysis in conjunction with JVH Compliance team.
• Oversee required federal and state reporting, including HPMS submissions, attestations, reportable events, grievances, appeals, and critical incident notifications.
• Develop and manage annual quality work plans, monitoring activities, audit tools, and dashboards to identify trends, risks, and improvement opportunities for Jordan Valley Senior Care.
• Lead or co-lead Quality Improvement Committee activities and partner with clinical, operational, compliance, and executive leaders on quality initiatives.
• Manage formal quality improvement projects using structured methodologies such as PDSA, Lean, or similar frameworks for Jordan Valley Senior Care.
• Monitor quality performance measures related to preventive care, chronic disease management, medication safety, falls, pressure injuries, hospital utilization, participant satisfaction, and care planning.
• Oversee grievance, appeals, and mandatory reporting processes to ensure timely and compliant resolution for Jordan Valley Senior Care.
• Support fraud, waste, and abuse prevention efforts, including training, auditing, investigations, corrective actions, and regulatory reporting for Jordan Valley Senior Care, in collaboration with JVH Compliance team.
• Partner with leadership and department managers to maintain current policies, translate regulatory updates into operational changes, and support staff training for Jordan Valley Senior Care.
• Promote a culture of quality, accountability, transparency, regulatory readiness, and ethical conduct across Jordan Valley Senior Care.

Benefits Overview:

• Medical and Prescription Drug Coverage: Three comprehensive plan options (Buy-up, Base, and High Deductible) through UnitedHealthcare's Choice Plus network, covering various deductibles and out-of-pocket limits. Includes access to telemedicine services via Teladoc.
• Health Savings Account (HSA): Available for employees in the High Deductible Plan with employer contributions and tax advantages.
• Flexible Spending Account (FSA): Options for both healthcare and dependent care FSAs, allowing pre-tax contributions for qualified expenses.
• Dental and Vision Coverage: Dental insurance through Cigna's DPPO network and vision coverage through EyeMed's Insight network.
• Retirement Plan: Pre-tax and Roth 403(b) retirement plans with a 5% employer match starting after 30 days of employment.
• Life and Disability Insurance: Basic Life and AD&D insurance provided at no cost, with the option to purchase additional coverage. Long-term and short-term disability insurance are also available.
• Employee Assistance Program (EAP): Free confidential support for personal and professional challenges, including counseling and crisis intervention.
• Additional Voluntary Benefits: Options for critical illness, accident, hospital care, and pet insurance through MetLife.
• Pay on Demand Available.

Holidays:

• Nine paid holidays per year.

Health Requirements:

All employees are required to provide proof of vaccination for Flu, Hepatitis B and Tuberculosis (TB) as part of our commitment to maintaining a safe and healthy workplace.

Application Process:

Interested applicants should submit a resume and cover letter through the JVH career portal at Careers & Education - Jordan Valley. Applications will be accepted on a rolling basis until the position is filled.

Jordan Valley Health is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Required Qualifications:

• Bachelor's degree in healthcare administration, Public Health, Nursing, Health Information Management, or equivalent work experience.
• Minimum of 3-5 years of experience in managed care, Medicare/Medicaid compliance, or quality improvement, with at least 2 years in a supervisory or program management role
• Direct experience managing CMS audits, internal audit programs, or regulatory reporting is required
• Either one year of experience working with a frail or elderly population or, in the absence of such experience, receive appropriate training from the JVSC on working with a frail or elderly population upon hire.
• Basic Life Support (BLS) required, must obtain within first 90 days of employment

Preferred Qualifications:

• Experience working with Missouri state agencies (MO HealthNet, DHSS, DSS) preferred
• PACE experience preferred
• Prior direct experience in a PACE organization as a compliance or quality professional
• Familiarity with the National PACE Association (NPA) quality frameworks and industry benchmarks
• Experience with CMS audits or OIG investigations
• Knowledge of Missouri Adult Protective Services system and mandatory reporting procedures
• Experience implementing PDSA cycles, Lean methodology, or similar QI frameworks in healthcare settings