Quality Services Specialist

Madison WI 53703

Job Description

TMG by Magellan Health is seeking a Quality Services Specialist who will provide a variety of quality services to TMG IRIS Consultants and others who work with IRIS, a state of Wisconsin long-term care program and the Self-Directed Personal Care (SDPC) Oversight Agency. These services include, but are not limited to providing consultation and education to a statewide workforce, quality assurance activities, and continuous quality improvement projects. The Quality Services Specialist will conduct record reviews, facilitate needed remediation, review incident reports and assist with resolution plans, issue notices of action, participate in hearings and appeals, and address program integrity concerns. In addition, this position may be involved with survey feedback data, public speaking, and presenting training programs for staff. Experience working with adults who have disabilities is preferred.

Essential Functions

  • 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, 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 program integrity issues such as potential fraud and/or abuse of IRIS funds, support participants to manage their IRIS budgets, and identify and mitigate potential conflicts of interest. 
  • Provide support for critical incident reporting, behavioral support plans, restrictive measures, fulfill record requests, assist with surveys, and conduct quality reviews as needed.
  • Respond to formal grievances and facilitate conference calls to brainstorm solutions to complaints, grievances and/or 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 participate in team meetings, along with other duties as assigned.

General Job Information

Title

Quality Services Specialist

Grade

21

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/30/2019

Date Requisition Created

5/29/2019

Minimum Qualifications

Education

Bachelors: Healthcare

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Preferred Qualifications

  • Bachelor's degree in Healthcare, Human Services, Social Work or other related field.
  • Experience working with adults with disabilities and/or seniors who experience chronic health concerns.

Required Qualifications

  • 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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