A. Overall Purpose Of The Job (Brief description of the primary purpose of this position) The Remote Quality Assurance Lead (RQAL) is responsible for driving patient quality through continuous improvement in service experience design, implementation and analysis. 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. The RQAL will lead quality initiatives and processes and oversight of customer service / service recovery responses; ensuring that documentation of complements, complaints, grievances and potential quality incidents are captured in the TOP customer feedback system (Riskman360. 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). 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. 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 contract-specific KPIs. C. Job Profile
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
• Working knowledge of Microsoft Office applications
• Knowledge or familiarity with the TRICARE Overseas Program (preferred) • Computer literate and able to learn/adapt to International SOS specific software programs Required Competencies (Critical behaviors necessary to successfully perform the job)
• Customer service oriented
• Empathetic and able to positively influence the customer journey experience
• Team player • Has initiative and takes responsibility. Required Work Experience (Brief description of the job-related experience needed to perform the job)
• International experience preferred
• Knowledge of Healthcare culture and legislation
• Experience in influencing and interfacing confidently with stakeholders on all aspects of service delivery.
• Proven track record in positive approach to responding effectively and professionally to customer feedback.
• Graduate nurse with a minimum of 3 years nursing experience
• Experience in one or more of the following fields:
o Healthcare quality management/assurance. o Medical facility accreditation in one or more areas
o Implementation or conducting of medical facility or departmental review/audit programs
o Medical facility administration in provision of healthcare services
o Medical outsourcing of services to provider network
o Healthcare network development / management
o Familiarity/experience with international healthcare - either working/interfacing in international healthcare environment
o Healthcare insurance or medical/travel assistance in area of managed healthcare utilizing provider networks Required Qualifications (Brief description of the educational background needed to perform the job)
• 3 years’ post graduate experience working in a health related field
• Or equivalent Military experience • Bachelor’s Degree in Nursing • This position does require someone who can obtain a Tier 1 background investigation for a position of trust after being offered a position and maintaining after starting with International SOS. Required Languages: • English required and a second regional language preferred Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
• This position may require international travel This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review. International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.