Quality Specialist II- New Mexico

Magellan Health • Albuquerque, NM

3d

About The Position

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.

Requirements

• 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.
• 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.

Nice To Haves

• LSSGB - Lean Six Sigma Green Belt Certification - EnterpriseEnterprise
• LSSWB - Lean Six Sigma White Belt Certification - EnterpriseEnterprise

Responsibilities

• 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.

Benefits

• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees