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.

CA State Behavioral Health Licensure

General Job Information


Senior Quality Specialist - Healthcare



Job Family

Quality Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience



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


  • Preferred Qualifications: RN with behavioral health experience or behavioral health licensed clinician.
  • 1-3 years of 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.
  • Strong working knowledge of Microsoft Excel, VISIO and MS Project.

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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