Quality Services Specialist
Madison WI 53703 1 South Pinckney St
Job DescriptionTMG by Magellan Health is seeking a Quality Services Specialist who is responsible for working as part of the Quality Services Team to provide an array of support services to internal and external customers of the IRIS Program, a state of Wisconsin long-term care program and the Self-Directed Personal Care (SDPC) Oversight Agency. These services include, though are not limited to, consultation, education and support, issue resolution and mediation, and support and expertise for process improvement and system change projects. The Quality Services Specialist may be responsible for assisting with quality assurance activities such as record reviews, addressing complaints and grievances, incident reporting, notices of action and appeals, and program integrity. In addition, this position may be involved with listening sessions, survey feedback, focus groups, and public speaking.
- Conduct internal quality reviews and assist with internal and external required remediation to ensure standards meet or exceed state compliance thresholds.
- Provide consultation, education and support to TMG Community-based staff including Associate Directors, IRIS Consultant Supervisors, IRIS Consultants and external stakeholders regarding implementation of the Department of Health Services IRIS program policies and procedures.
- Provide assistance to resolve situations involving IRIS program participants and guardians.
- Issue notices of action, compile hearing documentation and participate in fair hearings.
- Assist staff with reported alleged fraud and/or abuse of IRIS funds, support participants to manage their IRIS budgets and identify and mitigate conflicts of interest.
- Provide support for critical incident reporting, behavioral support plans, program integrity, restrictive measures, fulfill record requests, assist with surveys, and conduct quality reviews as needed.
- Respond to formal grievances and facilitating conference calls to discuss solutions to complaints, grievances and complex situations.
- Provide in-person and/or web-based training to a statewide workforce.
- Assist with other projects, create reports, document activities within the database, and attend team meetings, along with other duties as assigned.
General Job Information
TitleQuality Services Specialist
Job FamilyQuality Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date4/1/2019
Date Requisition Created4/1/2019
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 1-3 years quality improvement and auditing or related in healthcare field.
- Knowledge of healthcare quality improvement processes and performance measurement.
- Attention to detail and ability to work efficiently to meet deadlines and timelines.
- High degree of organization required.
- Expertise in data management, data analysis, reporting word processing, and project management skills
- Knowledge of Microsoft Excel, Microsoft SharePoint and Microsoft Teams
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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