Senior Quality Specialist, Health Plans


Remote position available

Job Description

After training, this position can be remote with 1-2 days/week in the Richmond, VA office or more as needed.

The Sr. Quality Specialist, Health Plans oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs for the health plan. Ensures maintenance of programs for members in accordance with quality, state, federal and accreditation standards. Provides direction and guidance regarding new and existing initiatives for the health plan.

Essential Functions

  • Conducts data collection, reporting and monitoring for key performance measures 
  • Provides direction for implementation of state, federal and accreditation compliance activities 
  • Implements key quality strategies which may include initiation and management of provider, member and community interventions 
  • Leads member outreach activities 
  • Writes and implements state Performance Improvement Project (PIP) and Plan Do Study Act (PDSA) submissions according to state contract requirements 
  • Monitors and ensures that key quality activities are completed on time and accurately in order to present results to health plan leadership 
  • Creates and manages required documentation to maintain critical quality improvement functions 
  • Evaluates project activities and results to identify opportunities for improvement 
  • Presents programs and program results to the health plan’s quality committee 
  • Identifies any gaps in process that require remediation 
  • Interprets regulatory specifications specific to intervention implementation 
  • Provides documentation of QI compliance for survey, state, federal and accreditation compliance  
  • Performs other duties and projects as assigned 

General Job Information


Senior Quality Specialist, Health Plans



Job Family

Quality Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications


Bachelors: Healthcare (Required)

License and Certifications - Required

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt

Other Job Requirements


Preferred Qualifications:

  • Certified Professional in Health Care Quality (CPHQ)

  • Demonstrated experience in leading significant cross-functional work
  • Experience with data reporting, analytics and interpretation
  • Project management experience
  • Excellent knowledge of HEDIS, NCQA, Medicare Stars and Medicaid
  • Conceptual and in-depth knowledge of the healthcare industry
  • Ability to manage relationships with an emphasis on internal and external mid-level relationships
  • Ability to work across all levels of the organization, including working with executive audiences, vendors and the government as a customer
  • Demonstrated ability to select and implement strategies that are most likely to be successful
  • Minimum five years experience in managed care
  • Internal audit experience

Required Qualifications:

  • Bachelor’s degree in healthcare or related discipline 
  • Three plus years of experience in quality management 
  • Demonstrated understanding of healthcare industry standards, HEDIS and NCQA 
  • Experience creating HEDIS campaigns to address gaps in care
  • Proficient in Microsoft Office tools 
  • Demonstrated solid business writing experience 
  • Strong analytical skills and strategic thinking
  • Strong communication skills, both verbally and written 
  • Ability to interact effectively with business owners, senior management, and peers across the organization

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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