manager, crew medical Quality ControlRoyal Caribbean Cruises

The Crew Medical Quality Control Manager is responsible for ensuring that Crew Medical processes are compliant with set standards and for identification of opportunities for process improvement and staff development. Compliance will be monitored through case reviews and standardized reporting for both shipside and repatriated claims. Standards that will be audited and reviewed will include:
Compliance with policies and procedures
Compliance with Key Process Indicators (KPIs)
Accuracy and reporting of claim reserves
Compliance with all applicable United Sates federal laws (46 USCA Sec. 688/Jones Act prompt, proper and adequate medical care) and HIPAA and EU's GDPR relating to privacy of medical records and personal identifiable information
Completeness of medical documentation
Review of crew satisfaction surveys for opportunities
Review of represented claims for trending of root cause/issues/possible mitigation
This leadership position will also assist with training of new staff and serving as a resource for the Crew Medical team as a subject matter expert. He/She may also facilitate or lead special projects. Lastly, this position will also participate in the Crew Medical Manager On-Call rotation-which requires 24/7 availability for after-hours and/or key incidents/authorizations as needed for one week about once/month or as needed.
Essential Duties and Responsibilities:
Review and monitoring of medical signoffs for appropriateness and compliance with policies and procedures
Reviews claims for appropriate reserve setting and claim reporting and updating to clubs
Reviews Riskonnect and SeaCare system entries to evaluate case manager effectiveness, accuracy, and completeness of documentation.
Manages, analyzes, and reports on the crew satisfaction survey results to evaluate satisfaction and opportunities with the medical leave process.
Develop/Analyze/Monitor metrics of Crew Medical KPIs and statistics to determine trends, appropriateness, control costs, identify areas of opportunity.
Prepares monthly status reports on case file reviews and communication with crew and makes recommendations for continuous quality and process improvement. Analyzes information gathered from case file reviews to identify areas of opportunity and improve the quality of medical case management. Advises the Crew Medical Director and Managers with observations and recommendations concerning overall case management and issues presented by specific cases.
Serve as resource to case managers to evaluate claims with adverse incidents and high-risk cases (e.g. medical emergencies, medical disembarkations, deaths, missing persons and crime victims), long term medical issues, and significant injuries to identify possible opportunities, mitigate any legal issues.
Identify opportunities for process and communication improvements with internal partners including Medical Operations and PEME teams, Shipboard medical teams, Ship HR Business Partners, and Network Management. External partners include clinical providers, port agents and transportation partners.
Train case managers and medical providers on legal and medical ethical issues as pertaining to Maritime legal issues, our corporate responsibilities and effective risk management and mitigation. Audit legal claims and collaborate with legal team in identification of opportunities, issues, and trends.
Participate in hiring and training of new employees in areas such as policy, department procedures, and departmental or international regulations. Participate in performance development and evaluation of staff.
Performs other duties as required. This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to perform other job-related duties assigned by their supervisor or management.
Qualifications:
Bachelor's degree or equivalent experience in health care or case management required.
Minimum of three (3) years case management experience in handling Maritime/Jones Act and/or personal injury cases.
Quality control, leadership and/or training experience preferred
Ability to work flexible work schedules and occasional weekend days to support fleet and department as assigned and/or required. Work shift changes may be required based on business necessity (high season/itinerary changes and time zone).
Customer services training preferred
Registered Nurse (RN)
Knowledge and Skills:
Strong independent decision-making ability regarding care management plan for ill/injured crew based on merits of each case and review of all medical records and treating physician recommendations.
Excellent communication skills both written and verbal. Ability to read, analyze and interpret business/professional documents.
Effectively organize and present information to management, staff and other audiences as needed
Ability to speak English. Bilingual preferred but not required. (i.e., Spanish, Tagalog)
Understanding of medical terminology
Able to effectively summarize complex and at times, voluminous medical records.
Detail oriented
Ability to perform basic math, compute, calculate, percent and to interpret bar graphs.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Collaborative style when interacting with coworkers and effectively contributes to a team environment.
Computer Skills required: Microsoft Office, Lotus Notes, PeopleSoft. Needs to know Riskonnect and SeaCare for the management of cases.
Royal Caribbean Cruises

Philippines
Permanent
Full-time