Supports the collection, analysis and reporting of data and the development of interventions strategies in support of improvement activities targeting quality, operational measures and service. Performs a variety of tasks related to the education, measurement, corrective actions, maintenance and promotion of the Quality Improvement Program; assures compliance with federal policies and guidelines of regulating and accrediting bodies such as CMS, URAC and NCQA. Under the supervision of the Quality Manager and leaders of the Quality Committee implements, analyzes, monitors and documents the Quality Improvement Program.
1.Converts data found in various databases into information that supports the decision making process of quality issues.
2.Develops written reports inclusive of quantitative and qualitative analysis outlining conclusions and recommendations for improvement.
3.Collaborates with the Quality Manager in the development and implementation of URAC, HEDIS and NCQA activities.
4.Plans and organizes the Quality Committee meetings. Is responsible, in coordination with the Committee's leaders, of the creation of the agenda, indicators reports and minute of the meeting.
5.Performs data entry and maintains a registry of: gathered information, the Quality Indicators Report and Departmental Corrective Action Plans.
6.Provides follow-up to corrective action plans.
7.In charge of coordinating Quality Audits to the Providers Network. Responsible of creating all final reports of these audits according to the reports sent by quality auditors.
8.Develops, in conjunction with the Quality Manager, the Quality Educational Plan, which targets the Providers Network, patients and employees.
9.Supports quality improvement initiatives including data management and reporting, health insurance incentive programs, population health management and other value-based reimbursement programs.
Coordinates and performs internal and external audits according to the Annual Quality Auditing Plan, including but not limited to: timeframe of service coordinations,, Providers Quality Performance, Case Management and Pharmacy Department.
Performs quality improvement and measurement reports both monthly and on a quarterly basis, according to all measurement and monitoring activities of the indicator reports.
Participates in all mandatory annual trainings.
Complies with all standards of the Service of Excellence Program.
Available to travel all around the Island.
Will perform any other task required by the Quality Manager.
Education: Master's degree in Quality Management, Public health, or health related fields.
Relevant work experience: 2 years or more of experience
Fully Bilingual (Spanish and English)
Skills of communication at all levels of the organization
Intermediate to advance proficiency in excel functions and other Microsoft Office programs.
Preferable knowledge in Lean Six Sigma and/or Project Management
Universal Health Services