Quality Improvement Analyst - TSS

About the position

At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.

Responsibilities

• Responsible for 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.