Senior Quality Specialist

Cambridge MA 02141 58 Charles Street

Job Description

RN STRONGLY PREFERRED
Supports 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. Assists team with initiatives for the health plan.

Conducts data collection, reporting and monitoring for key performance measures 
● Supports implementation for state, federal and accreditation compliance activities 
● Implements key quality strategies which may include initiation and management of provider, member and community interventions 
● Conducts member outreach activities 
● Assists with gathering information related to a Potential Quality Issues (PQI) for the review nurse 
● Implements state Performance Improvement Project (PIP) and Plan Do Study Act (PDSA) submissions according to state contract requirements 
● Supports team to ensure that key quality activities are completed on time and accurately in order to present results to health plan leadership 
● Supplies documentation to maintain critical quality improvement functions 
● Presents programs and program results to the Sr. QI Specialist 
● Identifies any gaps in process that require remediation and shares with Sr. QI Specialist 
● Provides documentation of QI compliance for survey, state, federal and accreditation compliance  
● Performs other duties and projects as assigned 

General Job Information

Title

Senior Quality Specialist

Grade

24

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

6/3/2019

Date Requisition Created

6/3/2019

Work Experience

Quality

Education

Bachelors: Healthcare (Required), Masters: Healthcare

License and Certifications - Required

License and Certifications - Preferred

LSSBB - Lean Six Sigma Black Belt Certification - Enterprise, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements

Responsibilities

 Minimum one years of experience with member and provider outreach 
● Bachelor’s degree in healthcare or related discipline 
● Two plus years of experience in quality management 
● Demonstrated understanding of healthcare industry standards, HEDIS and NCQA 
● 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 

● Registered Nurse, or appropriate clinical licensure preferred 
● Demonstrated experience in leading significant cross-functional work 
● Experience with data reporting, analytics and interpretation 
● 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 
● One plus year experience in managed care 

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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