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Senior Quality Improvement Specialist (Remote in California)

Company: Magellan Health
Location: San Diego
Posted on: September 15, 2021

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

  • Lead 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 and/or SME in Accreditation (NCQA and/or URAC) requirements (where applicable).
  • Provides or supports direct interventions with members and providers to address gaps in care or compliance.
  • Prepares status reports on activities and outcomes of interventions and activities.
  • Providing consultation and training to staff on quality, accreditation, and core performance indicators measurement specifications.
  • Provide assistance as needed in data maximization efforts through coordination with the company's Central HEDIS team (where applicable).
  • Lead CQI (continuous quality improvement) processes and studies related to improved outcomes.
  • Provides interface with internal and external customers for accreditation and/or HEDIS (where applicable)  planning, reporting and program enhancements.
  • Responsible or supports Quality Improvement Activities and established ROI.
  • Able to work independently.

Other Job Requirements


  • Experience in Lean Six Sigma.-MA in health care or related field.
  • CPHQ - Certified Professional In Healthcare Quality.
  • 5+ years of quality improvement and auditing or related experience in healthcare field.
  • 5+ years of HEDIS related experience (where applicable).
  • Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.
  • Attention to detail and able to work efficiently to meet deadlines and timelines.
  • High degree of organization required.
  • Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.
  • Expertise and proficient in data management, data analysis, reporting word processing, and project management skills.
  • Independently develops, understands, and communicates the extrapolated data to stakeholders.
  • Proficient knowledge of Microsoft Excel, VISIO, Tableau, Cognos, 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.
  • Experience working independently & managing quality improvement activities resulting in Return on Investment (ROI).
  • Ability to take lead on projects and run meetings with stakeholders.

General Job Information


Senior Quality Improvement Specialist (Remote in California)



Work Experience



Bachelors: Healthcare (Required), Masters: Healthcare

License and Certifications - Required

License and Certifications - Preferred

CPHQ - Certified Professional In Healthcare Quality - Care Mgmt, LSSBB - Lean Six Sigma Black Belt Certification - Enterprise, LSSGB - Lean Six Sigma Green 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.

Keywords: Magellan Health, San Diego , Senior Quality Improvement Specialist (Remote in California), Other , San Diego, California

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