Job Information
Magellan Health Services Senior Quality Specialist in United States
This position is contingent on a contract award.
Serves as a member of the quality team at the national, regional or unit level. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes including URAC, NCQA and/or HEDIS (where applicable) and reported outcomes.
Lead assigned quality and process improvement activities which may include accreditation support, process improvement projects, quality studies, CQI (continuous quality improvement) process training for staff, prevention program coordination, care coordination initiatives, satisfaction survey coordination and follow-up, provider and member advisory groups (where applicable), tracking of adverse incidents, monitoring of performance guarantees, CAPs and customer related quality initiatives.
Knowledgeable and/or SME in Accreditation (NCQA and/or URAC) requirements (where applicable).
Provides or supports direct interventions with members and providers to address gaps in care or compliance.
Prepares status reports on activities and outcomes of interventions and activities.
Providing consultation and training to staff on quality, accreditation, and core performance indicators measurement specifications.
Provide assistance as needed in data maximization efforts through coordination with the company's Central HEDIS team (where applicable).
Lead CQI (continuous quality improvement) processes and studies related to improved outcomes.
Provides interface with internal and external customers for accreditation and/or HEDIS (where applicable) planning, reporting and program enhancements.
Responsible or supports Quality Improvement Activities and established ROI.
Able to work independently.
Other Job Requirements
Responsibilities
5+ years of quality improvement and auditing or related experience in healthcare field.
5+ years of HEDIS related experience (where applicable).
Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.
Attention to detail and able to work efficiently to meet deadlines and timelines.
High degree of organization required.
Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.
Expertise and proficient in data management, data analysis, reporting word processing, and project management skills.
Independently develops, understands, and communicates the extrapolated data to stakeholders.
Proficient knowledge of Microsoft Excel, VISIO, Tableau, Cognos, and/or MS Project.
Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.
Experience working independently & managing quality improvement activities resulting in Return on Investment (ROI).
Ability to take lead on projects and run meetings with stakeholders.
General Job Information
Title
Senior Quality Specialist
Grade
26
Work Experience - Required
Quality
Work Experience - Preferred
Education - Required
Bachelor's - Healthcare
Education - Preferred
Master's - Healthcare
License and Certifications - Required
License and Certifications - Preferred
CPHQ - Certified Professional In Healthcare Quality - Care Mgmt, LSSBB - Lean Six Sigma Black Belt Certification - Enterprise, LSSGB - Lean Six Sigma Green Belt Certification - Enterprise
Salary Range
Salary Minimum:
$70,715
Salary Maximum:
$113,145
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911