At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join 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!
JOB SUMMARY
This position assesses, analyzes and categorizes the adverse events identified in hospitals for all lines of business according to CMS indications. Ensures that adverse events program meets its intended goals; identifies any barriers and proactively conceives solutions. Will work closely with medical guidelines and regulations applicable.
ESSENTIAL FUNCTIONS
- Analyze adverse events using the clinical record to determine that the adverse event was preventable by the facility and provider.
- Analyze the medical files, determine the nature of the event, clarify the event and determine if it’s categorized as an Adverse Event.
- Refer and discuss preventable adverse events awarded with the medical advisor.
- Monitors each analyst’s review process to ensure correct application of auditing indicators.
- Develop and provide Adverse Events training to UM Clinical Review analyst twice a year.
- Participate in the development and updating of the Adverse Events Policies and Procedures Manual and its dissemination and orientation to providers.
- Perform operational and quality reports of preventable adverse events as required by ASES and prepare presentations to the QIC in a timely manner.
- Prepare a profile of providers according to their historical performance.
- Evaluate and identify quality indicators in the light of new trends in medicine, regulatory agencies, and accreditation bodies to use them in audits and evaluations.
- Performs all other duties as assigned by the supervisor.
EDUCATION
- Bachelor's Degree in Science or Health
EXPERIENCE
Bachelor’s degree in science or health related field with one to three years of clinical experience, preferable in a health industry.
LICENSES AND CERTIFICATIONS
- None required
COMPETENCIES
- Manages Ambiguity
- Instills Trust
- Collaborates
- Customer Delight (Employee)
- Action Oriented
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, 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 People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.