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General Description •Research, development and maintenance of quality measures. Responsible for presentation, coordination, implementation and execution of measures while ensuring consistency with company strategy, commitments and goals. Responsible in analysing data for Medical Quality Management, identify weaknesses and develop creative solutions and ensure proper implementation through effective and efficient coordination with internal and external stakeholders of Medical Quality Management unit in Daman. Main Duties •Perform research and development of clinical, financial and structural measures by documentation and coding •Develop and convey logic of measures based on evidence based guidelines to the analytics team •Maintain coding and documentation of quality measures •Evaluate provider and clinicians’ behavior, utilisation and resulting clinical outcomes considering Evidence Based Guidelines •Coordinate with medical units for data collection, evaluation and interpretation •Coordinate operational changes, conduct workshops, analyse feedback, ideas and needs •Prepare and present Medical Quality reports for internal and external stakeholders •Prepare and present quality measure recommendations to the panel •Ensure that business decisions and processes are documented in a professional way and that communication requirements are being adhered to in a timely and professional manner •Provide training on quality measures for the providers •Develop solutions in form of recommendations based on the evaluation findings or measure requirements
•Good leadership skills including people management, selection and development skills •Well-developed presentation, strong communication skills with ability to communicate appropriately at all levels of the organisation; this includes written and verbal communications as well as visualisations •Very good analytical, planning, forecasting, execution and problem solving skills •Ability to acquire and apply new skills •Flexible and able to work under pressure •Respect and promote trust and confidentiality •Results oriented whilst ensuring high quality of work and able to “think out of the box” •Strong level of customer service orientation and professionalism in all interactions •Able to manage a multi-cultural environment and promote teamwork and knowledge sharing in order to achieve goals and deliverables •Good knowledge of health insurance concepts •Good knowledge of Microsoft applications; particularly Excel and Access •Very good knowledge of quality standards •Well organised and able to process and present data in structured manner and excellent documenting skills •Very good understanding in UDM model and SAS scripting