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, MOS
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.
Top Skills
What We Do
Magellan Health is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan's customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators.
