Quality Improvement Analyst - TSS

About the position

Responsible for identifies areas for improvement, develop and implement strategies to improve and maintain quality among the organization. Analyze data and reports on trends and regulatory agencies compliance requirements. Executes activities related to the identification and monitoring activities of the quality improvement programs. Responsible for the monitoring for the Quality Programs such CCIP and PIP ensuring compliance with regulatory agencies including but not limited to ASES, CMS, among others.

Responsibilities

• Responsible of the evaluation of the information and requirements of the regulatory agencies related to the Quality Improvement Projects (QIP) and Chronic Care Improvement Program (CCIP) consistent with CMS, ASES and/or other regulatory agencies rules and regulations and Triple S policies and procedures.
• Develop and update the CCIP annual training for employees and providers.
• Request corrective action plans, root cause analysis and business impact analysis to operational areas about the findings identified as a result of the monitoring activities.
• Produce high quality monitoring reports and presentations for Management and the QIC in compliance with CMS, ASES and the applicable regulatory agencies' requirements in a timely manner.
• Monitor operational dashboards that includes the results of each initiative established for complying with CMS requirements, current actions that are in place to increase compliance, barriers encountered, and future projections.
• Executes activities related to the identification and monitoring activities of the Chronic Care Improvement Program (CCIP) including keep updated the narrative of the program for MA and Platino.
• Assist in the evaluation of the Performance Improvement Projects (PIP), collaborate with the operational areas to keep the PIP updated with current information and results.
• Develop and maintain a monitoring plan for quality indicators of Delegate Entities assigned.
• Responsible for ensuring compliance with the Core Measures report as requested by ASES and share results with medical groups in a timely manner.
• Performs all other duties as assigned by the supervisor.

Requirements

• Bachelor's Degree in Sciences, Arts or Health related.
• Three to five years' experience working with Healthcare Audits or Compliance.
• URAC/NCQA or other accreditation process experience preferred.