[Hiring] Quality Specialist II @Magellan Health

Role 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 URAC, NCQA, and/or HEDIS (where applicable) and reported outcomes.

• Coordinates assigned quality and process improvement activities which may include:
  • Accreditation support
  • Process improvement projects
  • Quality studies
  • CQI (continuous quality improvement) process training for staff
  • Prevention program coordination
  • Care coordination initiatives
  • Satisfaction survey coordination and follow-up
  • Provider and member advisory groups (where applicable)
  • Tracking of adverse incidents
  • Monitoring of performance guarantees
  • CAPs and customer related quality initiatives
• Conducts quality control reviews and external/internal audits.
• Summarizes findings and prepares reports on findings.
• Assists in the preparation of customer audits.
• Conducts analyses of data findings for quality and process improvement and assists in report preparation for internal and external customers.
• Leads and/or supports assigned quality committees and/or work groups through comprehensive project management, ensuring that documentation is accurate and timely, agenda items presented, and follow-up actions taken.
• Supports the quality program with the goal to meet customer requirements and performance guarantees. Duties include monitoring and execution to meet timely deliverables.
• Works independently and high degree of organization required.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Qualifications

• 2+ years of HEDIS related experience (where applicable).
• 2+ years of quality improvement and auditing or related in healthcare field.
• 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.
• Knowledgeable in HEDIS (where applicable) and Accreditation (NCQA and/or URAC) requirements.
• Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.
• Excellent verbal and written skills and the ability to enter data accurately into spreadsheets and prepare professional looking documents and reports.

Requirements

• GED, High School (Education - Required)
• Bachelor's - Healthcare (Education - Preferred)
• LSSGB - Lean Six Sigma Green Belt Certification - Enterprise (License and Certifications - Preferred)
• LSSWB - Lean Six Sigma White Belt Certification - Enterprise (License and Certifications - Preferred)

Benefits

• Salary Minimum: $53,125
• Salary Maximum: $84,995
• This position may be eligible for short-term incentives as well as a comprehensive benefits package.
• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.