Senior Quality Specialist

Magellan Health Services Cambridge , MA 02138

Posted 4 months ago

Supports new and existing healthcare quality improvement initiatives and education programs for the health plan. Ensures maintenance of programs for members in accordance with quality, state, federal and accreditation standards. Assists team with initiatives for the health plan.

Conducts data collection, reporting and monitoring for key performance measures

Supports implementation for state, federal and accreditation compliance activities

Implements key quality strategies which may include initiation and management of provider, member and community interventions

Conducts member outreach activities

Assists with gathering information related to a Potential Quality Issues (PQI) for the review nurse

Implements state Performance Improvement Project (PIP) and Plan Do Study Act (PDSA) submissions according to state contract requirements

Supports team to ensure that key quality activities are completed on time and accurately in order to present results to health plan leadership

Supplies documentation to maintain critical quality improvement functions

Presents programs and program results to the Sr. QI Specialist

Identifies any gaps in process that require remediation and shares with Sr. QI Specialist

Provides documentation of QI compliance for survey, state, federal and accreditation compliance

Performs other duties and projects as assigned

General Job Information

Title

Senior Quality Specialist

Grade
24

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date
6/3/2019

Date Requisition Created
6/3/2019

Work Experience

Quality

Education

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

Responsibilities

Registered Nurse, or appropriate clinical licensure preferred

Demonstrated experience in leading significant cross-functional work

Experience with data reporting, analytics and interpretation

Excellent knowledge of HEDIS, NCQA, Medicare Stars and Medicaid

Conceptual and in-depth knowledge of the healthcare industry

Ability to manage relationships with an emphasis on internal and external mid-level relationships

One plus year experience in managed care

Minimum one years of experience with member and provider outreach

Bachelor's degree in healthcare or related discipline

Two plus years of experience in quality management

Demonstrated understanding of healthcare industry standards, HEDIS and NCQA

Proficient in Microsoft Office tools

Demonstrated solid business writing experience

Strong analytical skills and strategic thinking

Strong communication skills, both verbally and written

Ability to interact effectively with business owners, senior management, and peers across the organization

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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Senior Quality Specialist

Magellan Health Services