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.
2+ years of quality improvement and auditing or related in healthcare field.
2+ years of HEDIS related experience (where applicable).
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.
Knowledgeable in HEDIS (where applicable) and Accreditation (NCQA and/or URAC) requirements.
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.
Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.
Attention to detail and ability to work efficiently to meet deadlines and timelines.
Expertise in data management, data analysis, reporting word processing, and project management skills.
Strong working knowledge of Microsoft Excel, VISIO, and/or MS Project.
Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.
Other Job Requirements
Responsibilities
2+ 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.
General Job Information
Title
Quality Specialist II
Grade
23
Work Experience - Required
Quality
Work Experience - Preferred
Education - Required
Education - Preferred
Bachelors - Healthcare
License and Certifications - Required
License and Certifications - Preferred
LSSGB - Lean Six Sigma Green Belt Certification - Enterprise, LSSWB - Lean Six Sigma White Belt Certification - Enterprise
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
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