Job Description
Job Description
Quality Monitoring and Compliance:
- Monitor healthcare providers and internal processes to ensure compliance with national healthcare regulations (e.g. NHIS, HMIS, NAFDAC standards).
- Conduct regular audits and evaluations of clinical and operational processes.
- Review patient care records to ensure they meet defined standards.
Policy and Procedure Development:
- Assist in the development, review, and implementation of quality assurance policies and procedures.
- Update internal QA manuals and documentation in line with regulatory changes.
Data Analysis and Reporting:
- Collect, analyze, and report data on service delivery outcomes, including patient satisfaction, adverse events, and claims audits.
- Generate QA performance reports and present findings to management.
Provider Network Evaluation:
- Participate in accreditation and periodic assessments of hospitals, clinics, and other healthcare providers within the HMO’s network.
- Provide feedback and recommendations to providers for quality improvement.
Risk Management:
- Identify and report potential risks to patient safety or service quality.
- Assist in root cause analysis of complaints, errors, or adverse events, and suggest corrective actions.
Staff Training and Support:
- Support training and sensitization of internal staff and healthcare providers on quality standards, protocols, and best practices.
- Guide healthcare providers in implementing corrective actions.
Client and Provider Relations:
- Address and resolve quality-related complaints from enrollees and providers.
- Liaise with healthcare providers to ensure standards of care are upheld.
Temporary Support Duties:
- Fill in for permanent QA staff during absences or peak periods.
- Provide continuity in QA activities during staff transitions.
Requirements
- An MBBS with minimum of 3 years cognate experience in similar position. Knowledge in the managed health care industry is an added advantage.