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#0419-RB6205-TM
Supplemental Questionnaire

Last Name
First Name
1.

Have you graduated from an accredited four-year college or university with a major in business analytics, computer science, mathematics, finance, business, or public administration, or a closely related field?
Yes No
 

If you answered yes to question #1, identify the following:

  • Name of educational institution in which you graduated from
  • Type of degree
  • Academic major
2.

Do you possess a Lean or Six-Sigma certification? 
Yes No
 

If you answered yes to question #2, provide the following:

  • Type of certification
  • Name of entity in which certification was obtained from
  • Date certification obtained
3.

Do you possess two years experience conducting professional, quantitative analysis of programmatic, and/or operational business data in an acute care hospital, a sub-acute care or a long-term care environment utilizing business analytics methodologies, as well as developing and presenting process improvement recommendations applied to clinical operations or clinical program development.
Yes No
 

If you answered yes to question #3, provide the following requirements in detail:

  • Name of the acute care hospital, sub-acute care or long term health-care environment in which your direct professional, quantitative analysis of programmatic and/or operational business data experience was obtained.
  • Detailed description of your experience utilizing business analytics methodologies, as well as developing and presenting process improvement recommendations applied to clinical operations or clinical program development. Included in your answer, the performance/process improvement tools/approaches you utilized.
  • Timeline of employment performing the duties you identified.
4.

Do you possess experience in developing and implementing health care IT system process improvements to meet organizational business in a management or consulting capacity?
Yes No
 

If you answered yes to question #4, identify the following:

  • Position title
  • Name of employer
  • Timeline of employment
  • Process improvement recommendations for clinical operations/programs developed