Senior Behavioral Health Quality Specialist

Magellan Health
Full time
Business Management
United States
Hiring from: Anywhere

Senior Behavioral Health Quality Specialist – Remote


Location United States, United States Minor Outlying Islands, 99999 Category Quality Job Id R00000036158


Candidates with experience in Behavioral Health and Medicaid are strongly preferred


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 HEDIS (where applicable) and reported outcomes.



  • Serves as QI specialist for the quality program with the goal to meet customer requirements and performance guarantees. Duties include coordinating Quality/ Accreditation/Delegated initiatives and project plans, monitoring and execution to meet timely deliverables.

  • Provides direct interventions with members and providers to address gaps in care.

  • Develops, in collaboration with the customer and communication department, informational and training materials for providers and members.

  • Coordinates with any vendors outreach and interventions.

  • Prepares status reports on activities and outcomes of interventions and activities.

  • Consults and trains staff on measurement specifications.

  • Provide assistance as needed in data maximization efforts through coordination with the company’s Central HEDIS team.

  • Coordinates CQI (continuous quality improvement) processes and studies related to improved outcomes.

  • Provides interface with customers, National Quality/Clinical and CCOE staff for HEDIS planning, reporting and program enhancements.


Education



  • Bachelors: Healthcare (Required), Masters: Healthcare


License and Certifications – Preferred



  • CPHQ – Certified Professional In Healthcare Quality – Care Mgmt, LSSBB – Lean Six Sigma Black Belt Certification – Enterprise, RN – Registered Nurse, State and/or Compact State Licensure – Care Mgmt

  • Experience in Lean Six Sigma.-MA in health care or related field.

  • Licensed clinician, RN.

  • CPHQ


Responsibilities



  • Knowledge of HEDIS/measurement specifications, accreditation standards and quality improvement processes.

  • 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 in data management, data analysis, reporting word processing, and project management skills.

  • 3-5 years quality improvement/HEDIS related experience


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