Job DescriptionServes 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 HEDIS (where applicable) and reported outcomes.
- Serves as QI specialist for the quality program with the goal to meet customer requirements and performance guarantees. Duties include coordinating Quality/ Accreditation/Delegated initiatives and project plans, monitoring and execution to meet timely deliverables.
- Provides direct interventions with members and providers to address gaps in care.
- Develops, in collaboration with the customer and communication department, informational and training materials for providers and members.
- Coordinates with any vendors outreach and interventions.
- Prepares status reports on activities and outcomes of interventions and activities.
- Consults and trains staff on measurement specifications.
- Provide assistance as needed in data maximization efforts through coordination with the company's Central HEDIS team.
- Coordinates CQI (continuous quality improvement) processes and studies related to improved outcomes.
- Provides interface with customers, National Quality/Clinical and CCOE staff for HEDIS planning, reporting and program enhancements.
Extensive experience in Quality, Accreditation, and Compliance Oversight.
General Job Information
TitleSenior QI Specialist
Job FamilyQuality Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date1/3/2019
Date Requisition Created1/3/2019
License and Certifications - Required
License and Certifications - PreferredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
Other Job Requirements
Knowledge of HEDIS/meaurement specifications, accreditation standards and quality improvement processes. -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 in data management, data analysis, reporting word processing, and project management skills3-5 years quality improvement/HEDIS related experience
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
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