QI and Compliance Analyst

West PACE; San Marcos (CA); Hybrid; USD 75,000 - 105,000; Full time

Benefits offered by this job

11 paid holidays

16 days PTO

5 days sick time

5% 403(b) company match

No on-call time

Annual education allowance

Professional growth

Job summary

West PACE is seeking a Quality Improvement and Compliance Analyst to monitor staff adherence to state and federal regulations and GMWP policies. You will partner with the leadership team to resolve compliance issues, support grievance processing, and ensure audit readiness.

This role requires experience with HIPAA privacy, EMR systems, and data analysis. You will develop training materials, track regulatory timelines, and promote a culture of privacy, quality and accountability across the

Qualifications

• Bachelor's degree in related field or 5 years of experience in PACE.
• Experience with data analysis and regulatory compliance.
• Knowledge of HIPAA privacy and security requirements.

Responsibilities

• Monitor staff compliance with state and federal regulations and GMWP policies.
• Assist with timely processing of grievances and appeals.
• Support audit readiness and documentation for HIPAA and PACE requirements.
• Develop training materials and conduct EMR trainings.
• Track regulatory timelines and data trends for service delivery.

Skills

Regulatory compliance

HIPAA knowledge

Data analysis

EMR systems

Documentation

Audits preparation

Communication

Training development

Education

Bachelor's degree or equivalent experience

PACE familiarity

Tools

MS Office Suite

Excel

PowerPoint

EMR software

Job description

Hybrid position

Join the Team Voted Best Place to Work in North County!

Why Work for Gary and Mary West PACE?

Because you're looking for more than just a job - you want work/life balance and the opportunity to make a meaningful impact in the lives of North County seniors and their families.

At Gary and Mary West PACE, we support your personal and professional well-being with:

• Generous pay and a comprehensive benefits package focused on your health and wellness.
• 11 paid holidays, 16 days of PTO, and 5 days of sick time.
• A 5% employer match to our 403(b) retirement plan.
• No on-call time – because your time matters.

We invest in our team with an annual education allowance and a commitment to professional growth, helping you expand your skills and advance your career.

You'll thrive in a supportive, mission-driven culture where collaboration feels like family. As part of our multi-disciplinary team, your voice is heard, and your work is truly valued.

Join us and do your best work-because here, your contribution matters.

About PACE

Philanthropists Gary and Mary West founded West Health with the mission of enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life, and independence. The Gary and Mary West PACE (Program of All-inclusive Care for the Elderly), affiliated with West Health (www.westhealth.org), is a non-profit that delivers medical, social, and behavioral services to the frail elderly to the North County of San Diego. This PACE center is entrepreneurial in nature and focuses on innovations and bringing new processes to the traditional PACE environment.

We're looking for passionate healthcare providers who want to be part of a team dedicated to enable seniors to live in their communities as independently as possible by providing compassionate, comprehensive health and supportive care.

One Team One Mission

Position Summary

Under the direct supervision of the Quality Improvement & Compliance Director, the Quality Improvement and Compliance Analyst monitors staff compliance with state and federal regulations and GMWP policies and procedures and partners with the leadership team to promptly resolve any compliance issues. . In addition, the Quality Improvement and Compliance Analyst assists in timely processing of grievances and appeals in accordance with state and federal regulatory requirements and GMWP policies and procedures set forth for each line of business. The Quality Improvement and Compliance Analyst facilitates collaborative relationships across GMWP teams and stakeholders to promote the GMWP values, team culture and mission.

Essential Functions

• Assist to collect QI department data including that specified in the QI plan and required by state and federal regulations.
• Conduct medical records audits as Monitor participant medical records for complete and timely documentation.
• Responsible for maintaining regulatory compliance of all medical records within HIPAA standards.
• Ensure that participant medical record is retained for a minimum required period as outlined in GMWP policies and procedures.
• Participate in ongoing EMR trainings and subsequent learning opportunities on system enhancement/upgrades and related workflows.
• Assist in the development of training materials, training content, and topics for on-going EMR training based on chart review and input from leadership and users.
• Track and trend Service Delivery Requests, assuring that all regulatory timelines are met.
• Track and trend Grievances and Appeals, ensuring that regulatory timelines are met.
• Assist the staff prepare for and successfully complete state and federal audits.

• Assist with PACE audits by preparing documents for desk review submission and, while auditors are on-site, assist the regulators navigate the EMR to access required information.
• Assist with audit plans and perform internal and external audits of workforce and provider compliance with federal and state regulations and all applicable contractual obligations;
• Facilitate the gathering and validation of data required to complete the annual HOS- M survey, with the goal of maximizing participation.
• Complete all required documentation in a timely and accurate manner.
• Protect privacy and maintain confidentiality of all company procedures and information about employees, participants and families.
• Follow GMWP policies and procedures and participate in any required Quality Improvement activities, staff training and meetings.
• Other duties as assigned.

Education and Certification

• Bachelor's degree in related field or 5 years of experience working in Program of All-Inclusive Care for the Elderly (PACE).

Skills and Experience

• Experience with managing data and conducting analyses using productivity suite software including complex spreadsheets and preferably relational and/or hierarchical databases.
• Experience working in an Electronic Medical Record strongly preferred.
• Possess knowledge of HIPAA Privacy and Security.
• Possess knowledge of state and federal PACE regulations and contractual requirements.
• The ability to meet deadlines and manage tasks accordingly.
• Must possess strong analytical and organizational skills, as well as professional verbal and written communication skills.
• Ability to work independently with minimal supervision and ability to multi-task.
• Competence in use of computers for business analysis and communication.
• Ability to exercise strict confidentiality with all aspects of the position.
• Demonstrated ability to work and communicate effectively with employees at all levels.
• Proficiency with MS Office Suite, Word, Outlook, PowerPoint and Excel.
• Minimum of 1 year of experience with frail elderly population, preferred.
• Ability to process accurate information in a timely manner.
• Excellent leadership, organizational, customer service and communication skills with seniors, their families and interdisciplinary team members.
• Highly motivated, self-directed, able to execute tasks in a quickly changing environment and make sound decisions in emergency situations.
• Experience and competency working with people from diverse backgrounds.
• Commitment to unlocking the full potential of our most vulnerable seniors.

Medical Clearance:

Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.

Job offers are contingent upon a successful pre-employment drug screen, background check, and physical assessment.

Gary and Mary West PACE provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, gender, gender identity, gender expression or sexual orientation or any other considerations made unlawful by applicable state or local laws.