MRx Quality Manager

Virginia, Utah, Florida, Missouri, Rhode Island

Job Description

Quality Manager with pharmacy claims processing experience, Medicaid QA Plan knowledge to manage contractual requirements and reporting. Experience with workflow analysis and activities that may impact performance guarantees related to audit findings and end to end quality management to drive process improvement.

The QA Manager is responsible for oversight of the QA Plan and will work with MDHHS to ensure that it is in alignment the Department’s needs and contractual requirements. The QA Manager works with staff in each department and measures and reports on the overall operations and testing. In addition, the QA Manager monitors workflow analysis and activities that may impact performance guarantees related to audit findings and serves as the liaison for all contract requirements. The QA Manager coordinates activities with the Testing Specialist, Call Center, and our MMA PBM Account Team. In addition, the QA Manager coordinates and monitors contractual deliverables, customer satisfaction survey(s), ongoing internal reviews, and results from regulatory activities.

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Essential Functions


-  Manages day-to-day quality activities ensuring program and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contract, federal and state requirements. Activities and projects may include:
-  Interfacing with customers on quality programs.
-  Trainings on CQI processes.
-  Coordination of quality initiatives.
-  Satisfaction survey coordination and follow-up.
-  Coordination of Advisory Groups.
-  Tracking of adverse incidents and Quality of Care concerns.
-  Monitoring of performance measures.
-  Provider profiling support.
-  Auditing for quality control.
-  Quality studies and quality improvement projects.
-  Prepares customer and site reports with assistance from Reporting and Analytics team.
-  Participates on quality committees to ensure quality issues are taken to the committee and recommendations are made, by the committee, in a timely manner. Makes recommendations to the Committee for improving plan operations based on data from performance indicators, QI studies, and quality activities.
-  Serves as liaison with assigned departments to ensure quality projects are integrated within operations.
-  Conducts internal audits of charts and clinical/service procedures for quality purposes.

General Job Information

Title

MRx Quality Manager

Grade

25

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/6/2019

Date Requisition Created

2/28/2019

Minimum Qualifications

Education

Bachelors: Healthcare (Required), Masters: Behavioral Health

License and Certifications - Required

License and Certifications - Preferred

LSW - Licensed Social Worker - Care Mgmt

Other Job Requirements

Responsibilities

Managed behavioral health and accreditation processes. Knowledge of accreditation standards related to the book of business.Knowledge of quality improvement processes and performance measurement. Demonstrated skills in project management. Strong interpersonal and organizational skills. Expertise in word processing and data management software.5 years healthcare quality improvement 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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