Senior Quality Specialist (Healthcare)

San Diego CA 92108

Job Description

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 HEDIS (where applicable) and reported outcomes.

Essential Functions


- 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.

General Job Information

Title

Senior Quality Specialist (Healthcare)

Grade

24

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

4/4/2019

Date Requisition Created

4/4/2019

Minimum Qualifications

Education

Bachelors: Healthcare (Required), Masters: Healthcare

License and Certifications - Required

License and Certifications - Preferred

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements

Responsibilities

-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 skills.

PREFERRED QUALIFICATONS:

-Licensed behavioral health clinician

-MA in health care or related field.

-Experience in Lean Six Sigma.

3-5 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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