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.

-  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.

Preferred Qualification:  Certified Professional Healthcare Quality (CPHQ)

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 (Required)

License and Certifications - Required

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt, LSSBB - Lean Six Sigma Black Belt Certification - Enterprise, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Other Job Requirements


  • 3-5 years quality improvement/HEDIS related experience 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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