Process Improvement Analyst jobs in Sunland Park, NM

Bienvivir All-Inclusive Senior Health (“Bienvivir”) is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly (“PACE”).

PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

BENEFITS for Full and Part-time employees who work 30 or more hours per week:

We pay 100% of the MEDICAL monthly premiums for Employee Only coverage.

We pay 100% of the DENTAL monthly premiums for Employee Only coverage.

We provide an affordable VISION monthly premium for Employee Family coverage.

We pay 100% of BASIC LIFE for a benefit amount of $10,000.

We offer safe harbor matching contributions for the 403(B) RETIREMENT SAVINGS account.

We offer up to fifteen (15) days of PAID TIME OFF based on paid hours per pay period.

We offer eleven (11) company-observed PAID HOLIDAYS.

We offer education and TUITION REIMBURSEMENT.

We offer MILEAGE REIMBURSEMENT.

Bienvivir is currently accepting applications for the following position:

QUALITY IMPROVEMENT GRIEVANCE ANALYST

Under the supervision of the Quality Improvement Manager, the Quality Improvement Grievance Analyst is responsible for ensuring that Bienvivir Senior Health Services responds to participant-related complaints in a timely, professional, and customer-focused manner and are completed in accordance with regulatory requirements and internal policies. The Quality Improvement Grievance Analyst will be responsible for investigating and resolving assigned cases, accurate and timely documentation of case actions, identifying trends and emerging issues that may contribute to or cause an atmosphere for participant dissatisfaction, and providing recommendations that promote continuous improvement in quality care and participant safety.

RESPONSIBILITIES:
1. Handle the grievance tracking and management process to ensure the efficiency and security of grievances.
2. Identify and extract data from different databases using data management skills and work with other departments as needed to ensure data quality (completeness, consistency, accuracy, validity, and timeliness).
3. Provide prompt, appropriate action, including a full investigation and resolution (verbal and written) of grievances in accordance with referred time frames.
4. Maintain an electronic central database with pertinent data required for grievance-related activities (e.g., nature of the complaint, complaint category, source of date of receiving the complaint, investigation status).
5. Monitor grievances, conduct statistical analysis and provide management with monthly reporting on identified trends regarding quality of care concerns and complaints.
6. Assist with the coordination of the Grievance and Appeals Committee and other committees as required.
7. Assist with the coordination and implementation of projects related to quality improvement and participant safety (i.e., departmental work plans review, fall prevention, ED utilization reduction, grievance reduction) and make recommendations for improving clinical and operational processes and eliminating risk trends that affect quality and participant safety.
8. Collect, reconcile, and analyze data elements for quarterly submission to the Health Plan Management System (HPMS).
9. Assist with the coordination of CMS Account Manager Quarterly Meetings and presentation of HPMS data (PACE Quality Indicators).
10. Work with departments and contractors to ensure problems are corrected and staff is advised of corrective measures to prevent recurrences.
11. Provide training and direction to departments and contractors in developing procedures to comply with grievance reporting requirements.
12. Responsible for other tasks as assigned.

QUALIFICATIONS / REQUIREMENTS:
1. Associates degree from an accredited University with current LVN licensure in the state of Texas and a minimum of 3 years clinical experience.
2. Prior experience in Health Care Customer Service.
3. Prior experience in use of Excel for creating and maintaining databases.
4. Knowledge in the collection, measurement, trending, reconciliation, and analysis of data.
5. Previous experience in quality assessment and/or improvement programs (preferred).
6. Understanding of Six Sigma methodology (preferred).
7. Bilingual (English/Spanish) verbal and written communication