Manager Quality Assurance at NHIMA

Job Description

Key Responsibilities

The key functions of the role will include but not limited to;

Policy

Develop, interpret, adhere and enforce compliance to and ensure implementation of policies of quality assurance to enhance adherence and compliance to the contractual and regulatory requirements..

Stakeholder & Facilities Outcomes

Coordinate quality assurance activities within the Authority;
Further, the role will be responsible for the on-going monitoring and evaluation of quality in health services delivered in accredited HCPs to ensure compliance to Regulatory Body’s and Authority prescribed quality standards throughout the tenure of agreement with NHIMA;
Must maintain a good relationship with all accredited health facilities;
Provide technical oversight to development of standards and tools for clinical audit and monitor and evaluate performance of the accredited HCPs to ensure adherence to National Standard Treatment Guidelines;
Provide technical oversight to the development and review of the Quality Assurance Manual;
Receiving, investigating and determining complaints by members and accredited health care providers;
Establish and maintains lines of communication with internal and external customers to ensure timely response to quality assurance needs and expectations;
Ensure that annual stakeholder surveys are done, and satisfactory perception outcomes are received from accredited health service providers;
Liaising internally with the Health Insurance Department on any relevant information that relates to quality of health service delivery trends and patterns by HCPs; and
Coordinate in collaboration with counterparts at the Ministry of Health (MOH) periodic engagement of accredited HCPs to jointly review of quality assurance performance of accredited HCPs.

Finance & Solvency Outcomes

Initiating, development in conjunction with Finance, Departmental expenditure estimates;
Managing quality assurance reporting, monitoring and evaluation within set cost parameters and budget.

Staff & Learning Environment Outcomes

To supervise a team of staff in the Quality Assurance Unit; Undertakes and ensure timely, supervisory activities to facilitate adherence to the scheme’s quality assurance standards by all technical and operational staff;
Oversee that quality assurance personnel have the appropriate education and experience, receive appropriate training and mentorship for the type and complexity of the services they offer including continuing professional development to improve skills and knowledge;
Ensure optimal staffing levels in the Quality Assurance Unit to meet Quality Assurance monitoring and evaluation of accredited HCPs;
In charge of staff development, performance management and staff career development in the Quality Assurance Unit; and
Ascertaining the training needs and staff technical support supervision within the Quality Assurance Unit.

Predictable Systems and Control Outcomes

Report on matters relating to service provider performance, customer satisfaction;
Use insights from reports to facilitate business processes and improvements in quality of health service delivery by accredited HCPs;
Coordinate training of accredited HCPs on NHI processes and customer services;
Integration & alignment of IT systems to incorporate Quality Assurance system requirements;
Designing relevant internal procedures, processes and practices that minimise the Authority’s risks of dealing with accredited HCPs;
Carrying out scheduled and unscheduled quality assurance inspections at points of delivery of insured HCPs;
To conduct periodic clinical audits and performance reviews of all accredited health care providers;
To conduct on-going inspection of health care providers’ premises, facilities and general infrastructure to ensure adherence to set standards;
Research and makes special visits to various health facilities with a view of ascertaining those which are recommended for initial , renewal or termination of accreditation and make the necessary review as needed;
To recommend for immediate remediation for all identified service gaps and follow up on the same;
To proactively meet all health care service providers to discuss, resolve or receive proposals for process improvement;
Deals with and/or takes measures to solve problems arising from management of clinical cases;
Working with the Health Care Providers so that they remedy any exceptions highlighted in previous clinical audits; and
Undertaking any task/assignment which the supervisor may delegate from time to time.

Education Requirements

Must have Grade twelve (12) School certificate with 5 ‘O’ levels with credit or better including Mathematics and English Language;
A degree in clinical medicine and a postgraduate degree in Management, Business Administration, Public Health, Clinical Medicine, Nursing or its equivalent from a recognized training institution; and
Must be familiar with the tools of monitoring and evaluation of quality assurance processes.

Required Skills

Must have 6-9- years in a similar role;
Must have a valid class ‘C’ driving licence;
Must be familiar with accepted general health and medical standards in Zambia and Worldwide;
Must be able to write comprehensive and analytical reports and PowerPoint Presentations;
Must be able to communicate effectively in English;
Must be Computer literate and have effective clinical investigative skills;
Must be proficient office applications such as Word, PowerPoint and many other relevant applications;
Must be assertive and decisive;
Must have good interpersonal skills;
Must have strong leadership skills and able to lead teams effectively;