249 Jobs Full Time Job In State Available In United States

Senior Quality Improvement Specialist

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Serves as a member of the quality team at the national, regional or unit level. Coordinates projects resulting in continuous quality improvement and p. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Sr Director, Digital Strategy And Insights

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

The Senior Director of Digital Strategy and Insights has the responsibility for setting and evolving Magellan’s digital strategy in support of our c. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Quality Specialist II

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Serves as a member of the quality team at the national, regional or unit level. Coordinates projects resulting in continuous quality improvement and p. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Senior Financial Analyst - Remote Opportunity!

Posted on:
07/12/2021

Magellan Health, Inc

Remote, United States

This position requires significant financial analytical experience and demonstrated health care industry knowledge. Primary responsibilities include . . .

Posted on:
07/12/2021
Apply Before:
08/09/2021

Clinical Pharmacy Technician (Remote)

Posted on:
07/12/2021

Magellan Health, Inc

Remote, United States

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic. . .

Posted on:
07/12/2021
Apply Before:
08/09/2021

Initial Clinical Reviewer II (RN)

Posted on:
07/06/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a su. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

Sr Product Innovation Manager

Posted on:
07/06/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Designs, develops and manages assigned products and services. Responsibilities include, but are not limited to conceptualizing, translating market res. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

VP, Sales 1, PBM Mid-Market SE

Posted on:
07/06/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Responsible for attaining sustainable sales growth through current and new customers for the Pharmacy Employer market in the assigned region. Oversees. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

Subcontracts Manager - Remote

Posted on:
07/06/2021

Magellan Health, Inc

Remote, United States

This role is responsible to work collaboratively with internal business leaders to capture business requirements, provide market analysis, develop neg. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

Physician Clinical Reviewer Physical Medicine And Rehab

Posted on:
07/06/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medica. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

Lead Proposal Writer - REMOTE

Posted on:
07/06/2021

Magellan Health, Inc

Remote, United States

Develops complex proposals that are well-written, accurate, consistent, responsive and reflect customer-specific themes. When necessary, can manage p. . .

Posted on:
07/06/2021
Apply Before:
08/03/2021

Senior Project Solution Manager

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Responsible for the management of a variety of projects for corporate and/or strategic business unit (SBU). Provides support through the planning and. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Medical Director - Psychiatrist

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

This position supports the clinical vision for the health plan(s) and implements programs to support this vision. May serve multiple health plans man. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Physician Clinical Reviewer Physical Medicine And Rehab

Posted on:
07/28/2021

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States

Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medica. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Advanced Analytics Consultant - Remote Opportunity!

Posted on:
07/28/2021

Magellan Health, Inc

Remote, United States

Under the leadership of the Director of Advanced Analytics, the Advanced Analytics Consultant is responsible for developing predictive models to guid. . .

Posted on:
07/28/2021
Apply Before:
08/25/2021

Senior Quality Improvement Specialist

Magellan Health, Inc

United States, United States Minor Outlying Islands, United States Estimated Salary : $ 63,403 per year Apply Now
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Job Type: Full Time

Category: Operations Management

Key Skills:

training Internship - <p>if You Make Hearts Beat Faster, Your Own Has To Be In The Right Place. Key Skills

  • Data Collection
  • Oncology
  • Registered Nurse
  • Interpretation Of Data
  • Provide Leadership

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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

Responsibilities

  • 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.
  • Experience in Lean Six Sigma.-MA in health care or related field.
  • CPHQ - Certified Professional In Healthcare Quality.

General Job Information

Title

Senior Quality Improvement Specialist

Grade

25

Work Experience

Quality

Education

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.