Manager, Quality - Healthcare

San Diego CA 92108

Job Description

Responsible for assigned areas of quality within a specified unit of a SBU. Implements assigned quality program components. Interfaces with customers and regulatory entities. May have accreditation responsibilities based on contract requirements.

Essential Functions

- Manages day-to-day quality activities ensuring program and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contract, federal and state requirements. Activities and projects may include:
- Interfacing with customers on quality programs.
- Trainings on CQI processes.
- Coordination of quality initiatives.
- Satisfaction survey coordination and follow-up.
- Coordination of Advisory Groups.
- Investigation of adverse incidents and Quality of Care concerns
- Research and resolve customer inquiries and provider disputes
- Monitoring of performance measures.
- Provider profiling support.
- Auditing for quality control.
- Quality studies and quality improvement projects statistical analyses and lean principles.
- Prepares customer and site reports with assistance from Reporting and Analytics team.
- Participates on quality committees to ensure quality issues are taken to the committee and recommendations are made, by the committee, in a timely manner. Makes recommendations to the Committee for improving plan operations based on data from performance indicators, QI studies, and quality activities.
- Serves as liaison with assigned departments to ensure quality projects are integrated within operations.
- Conducts internal audits of charts and clinical/service procedures for quality purposes

-Bachelor's degree with 5 years healthcare and quality experience.

- Leadership and management/supervisory experience.
- Quality techniques and tools, statistics, analytics, research
- Managed care/health plan experience.
- Writing skills -Qualitative and quantitative analysis
- Project Management experience, Process Improvement, development of corrective action
plans and tracking.
- Demonstrated ability to execute; strong ability to effectively communicate verbally.
- Advanced proficiency with Excel, any statistical software experience.

General Job Information


Manager, Quality - 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: Behavioral Health

License and Certifications - Required

License and Certifications - Preferred

LSW - Licensed Social Worker - Care Mgmt

Other Job Requirements


Managed behavioral health and accreditation processes. Knowledge of accreditation standards related to the book of business.Knowledge of quality improvement processes and performance measurement. Demonstrated skills in project management. Strong interpersonal and organizational skills. Expertise in word processing and data management software.5 years healthcare quality improvement 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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