Overview
Quality Control Analyst, Football Jobs in Stanford, CA at Stanford University
Quality Analyst
Ponce, PR
ABOUT US
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.
Let’s build healthier communities together, join now!
ABOUT THE ROLE
Monitors quality healthcare standards and performance improvement based on regulatory requirements, HEDIS measures and NCQA standards across all organizational areas, including beneficiaries, providers and delegated entities.
WHAT YOU’LL DO
Evaluate primary care physician and participating providers to determine the level of compliance with HEDIS measures.
Participates in educational and training strategies with providers and Organizational Areas to achieve Quality goals.
Coordinates and performs medical record revisions in order to collect clinical evidence for gap closure.
Develop and facilitate implementation of required action plans.
Responsible for preparing and submitting reports within timeframes.
Discuss the results of quality evaluations related to HEDIS measures, develop a plan of action and follows up.
Provide feedback to clients as needed.
Supports personnel and clients to evaluate and improve effectiveness of healthcare services.
Conduct weekly, monthly, quarterly and annual reports of activities.
Keep evidence of all interventions done.
Understands healthcare standards of care and clinical best-practices to monitor compliance.
Promotes policies and procedures following recognized standards of care, accreditation, compliance standards and guidelines, and other evaluating entities, including state and federal agencies.
Participates in proactive team efforts to achieve departmental and company goals.
Assists and collaborates in strategies to achieve goals for CMS Quality and Star Rating.
Apply basic knowledge in order to elevate report to next level if required.
Cross training within the Department.
Contribute and cooperate in any business matter related to the Quality and Stars Department.
Assists in educational and training strategies with providers and Organizational Areas to achieve Quality goals.
Maintains a professional, organized and clean work environment by following organizational policies and procedures. Performs other duties as assigned by supervisor.
WHAT YOU’LL BRING
Bachelor’s degree in Nursing or Healthcare field. With 1 to 3 years of experience in the Health Insurance Industry, preferable. Or Associates Degree (60-64) college credits in Nursing or Healthcare field with 3 to 5 years’ experience in the Health Insurance Industry, preferable. Or 5 years of this experience in lieu of.
CLOSING DATE: 02/01/2025
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
Title: Quality Control Analyst, Football
Company: Stanford University
Location: Stanford, CA
