Remote Quality Assurance Lead

at  International SOS

ABOUT YOU

• Bachelor’s Degree in Nursing, with a minimum of 3 years nursing experience
• Experience in one or more of the following fields:
• Healthcare quality management/assurance
• Medical facility accreditation in one or more areas
• Implementation or conducting of medical facility or departmental review/audit programs
• Medical facility administration in provision of healthcare services
• Medical outsourcing of services to provider network
• Healthcare network development / management
• Familiarity/experience with international healthcare - either working/interfacing in international healthcare environment
• Healthcare insurance or medical/travel assistance in area of managed healthcare utilizing provider networks
• Customer service oriented
• Empathetic and able to positively influence the customer journey experience
• Team player
• Has initiative, takes responsibility
• Ability to work independently

ABOUT THE ROLE

• The Remote Assurance Lead (RQAL) is responsible, on behalf of the Head of Clinical Quality for driving quality patient care through continuous improvement in service experience design, implementation, and analysis in the remote beneficiary locations.
• The RQAL will develop relationships with the TRICARE Area Office (TAO), Military Treatment Facilities (MTF), beneficiaries and Purchased Care Sector Providers (PCSP) to support the quality assurance function.
• They will design and follow initiatives to enhance customer experience through monitoring of survey results, undertaking focused reviews, trending and analysis of reports and monthly quality reporting.
• They will support the remote clinical team to capture updated clinical outcome data from providers.
• Working with the Network Clinical Quality Assurance Manager and Remote Network Site Assessment Nurses, remote medical teams, and TRICARE Relationship Managers / Country Leads, will assess and report on the quality and safety of providers up to and including auditing and credentialing TRICARE providers in a given area.
• Maintain daily communication with the global quality team, local remote medical teams, beneficiaries, medical providers, MTFs and TAO.
  The RQAL will lead quality initiatives and processes and oversight of customer service / service recovery responses, in partnership with the TRICARE Overseas Program (TOP) Program Management Office (PMO). The RQAL will help ensure that documentation of compliments, complaints, grievances, and Potential Quality Incidents (PQIs) are captured in the TOP customer feedback system (RiskMan360) to monitor and provide feedback on customer service provided in the Latin America & Canada region. 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 Clinical Quality Management Program / Clinical Quality Oversight Plan. This is done through the collection, collation and analysis of provider level data relating to the quality outcome program. 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.
  The RQAL will support the Regional Medical Director in raising and maintaining the quality of the remote medical teams assessments through case reviews and case feedback.
  All activities will be undertaken in strict compliance with HIPPA and other Privacy Regulations.

KEY RESPONSIBILITIES

• The RQAL will lead quality initiatives and processes and oversight of customer service / service recovery responses, in partnership with the remote teams.
• The RQAL will ensure that documentation of compliments, complaints, grievances and PQIs are captured in the TOP customer feedback system (RiskMan360) and track corrective action plans that result from investigations of grievances, Quality Incidents, customer feedback and defect trends.
• The RQAL is responsible for driving support for the TOP Clinical Management Program / Clinical Quality Oversight Plan through the collection, collation and analysis of provider level data relating to the quality outcome program.
• The RQAL will support the Regional Medical Director in raising and maintaining the quality of the remote medical teams’ assessments through case reviews and case feedback.
• The RQAL will support provider visits to develop relationships with the provider quality team, to support site assessment visits and to drive the regular update of clinical outcome data from providers.
• In consultation with the Clinical Quality Assurance and Innovation Lead and 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.
• Ensure beneficiary expectations are met from start to finish and work with PCSPS and remote medical teams where Patient Reported Experience Measures (PREMS) describe poor beneficiary centric care.
• Assists with targeted training of employees to ensure consistent and high-quality levels of customers service support.
• Conduct regular internal reviews on service delivery through case reviews and clinical audits, providing feedback to the teams, Regional Medical Director/ physician leads 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 teams.
• Assure that all appropriate personnel are trained on all SOP’s and that SOP’s are readily assessable to them.
• Participate in projects related to quality improvement initiatives.