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Healthcare Quality Assurance Lead
3 months ago
At International SOS we work to protect global workforces from health and security threats. We make a meaningful impact every day by safeguarding people and saving lives worldwide, 24/7.
A. Overall Purpose Of The Job _(Brief description of the primary purpose of this position)_
We are looking to add a new Nurse to our team as the Remote Quality Assurance Lead (RQAL). The RQAL is responsible for driving patient quality through continuous improvement in service experience design, implementation and analysis.
This is a hybrid position (3 days in office, 2 days remote)
- the "Remote" in title refers to the beneficiary population under TRICARE Overseas Program (TOP).
The RQAL will support development of relationships with the military treatment facilities, beneficiaries and purchased care provider offices.
This includes initiatives to enhance customer experience and expectations identified through monitoring survey results, focused reviews, calibration processes, trending and analysis and monthly quality reporting.
They will support the remote medical team to capture updated data from the providers on clinical outcome data; in close association with the local GAN members and Network Quality Assessment Teams, TRICARE Relationship Managers to assess and report on the quality and safety of providers up to and including auditing and credentialing TRICARE providers in a given area.
They will provide Quality assurance reviews on specific core processes will be conducted in accordance with the TOP contract. These functions will help ensure consistency of safe and effective service delivery to the beneficiaries.
The RQAL is responsible for driving support for the TOP Quality Oversight Plan and Quality Management/ Quality Improvement Plan (QM/QI).
They will work closely with TOP regional staff to undertake reviews and to develop and track corrective action plans that result from investigations of Grievances, Quality Incidents, customer feedback and defect trends.
All activities will be undertaken in strict compliance with HIPPA and other Privacy Regulations.B. Key Responsibilities _(Critical responsibilities and skills of this position, listed in order of importance)_
- Support provider visits to develop relationships with the provider quality team, to support GAN visits and to drive the regular update of clinical outcome data from providers.
- In consultation with the Head of Clinical Quality define, implement and administer key service quality guidelines and procedures
- Set targets for improvements in service quality to drive up standards in beneficiary satisfaction and safety of care.
- Implement proactive service quality improvement plan and initiatives, ensuring all parties understand their role in the plan
- Conduct regular internal reviews on service delivery through case reviews, clinical audits providing feedback to the teams, The in Country Physicians and the TOP Quality Team.
- Work with the Head of Clinical Quality to ensure appropriate capacity and support in place to complete audits and conduct workshops/focus groups.
- Collaborate with other members of the TOP Quality Organization in preparing and implementing training and development plans and in mentoring Country team.
- Participate in projects related to quality improvement initiatives.
Audit Requirements
- Perform routine audits including, but not limited to appeals, complaints, grievances and correspondence; provide timely feedback and any applicable coaching; coordinate any applicable remedial training with the supervisors of the individuals who receive feedback with an opportunity to improve; and document the process. Audits should be managed to meet all audit review KPIs and contractspecific KPIs.
Required Skills and Knowledge _(Brief description of technical knowledge or skills needed to perform the job)_
- Attention to detail
- Effective communication skills: Exercises discretion and judgment when providing feedback, guidance and clarification to ensure the relationship is protected
- Identifies and acts on potential problems and / or difficulties.
- Demonstrate appropriate listening skills
- Demonstrates effective problem solving skills and lateral thinking.
- Able to work under pressure and to prepare accurate and timely reports in line with the requirements of the TOP
- Ability to provide clear and concise written updates
- Knowledge or familiarity with the TRICARE Overseas Program (preferred)
- Computer literate and able to learn/adapt to International SOS specific software programs
