Magellan Complete Care (MCC) is the SBU accountable for Magellan’s Medicaid and Medicare managed care businesses. This position will lead quality for the MCC SBU and is accountable for the leadership, strategic planning and program outcomes for assigned national initiatives and assigned Magellan Complete Care Strategic Business Unit. The health plan quality programs are comprehensive, inclusive of medical, behavioral and long term services and supports benefits, compliant with state regulations, contracts and accrediting bodes, and are pro-active, member centered, performance driven and process improvement focused. The job responsibilities include the direction and leadership of a comprehensive quality program that meets state, contract and accreditation standards, has well defined processes and uses performance measurement as the foundation for quality and process improvements. As a member of the Magellan Healthcare senior clinical management team, participates in the development and implementation of organization-wide plans, goals and objectives.
- Leads and monitors a pro-active, clinically and operationally-driven quality and process improvement program for assigned units. The QI/PI program will meet operational goals, certification and accreditation standards, contract requirements and demonstrate use of Lean Six Sigma/ CQI principles and practices to identify opportunities for performance improvement and system interventions with demonstrated ROI. Duties include oversight, coaching, staff selection and training for assigned units? quality program which includes:
- Quality and process improvement programs with current policies, procedures and protocols, auditing mechanisms and data reporting systems.
- Staff supervision in identification of potential quality deficiencies.
- Quality control procedures using valid sampling and process review.
- Use of data for problem resolution.
- Quality initiatives, quality improvement activities and collaborative studies with customers.
- Process mapping and recommendations for efficiencies.
- Collaboration with management in developing process and system improvements.
- Per business business requirements, URAC and NCQA accreditation and certification activities with continuous monitoring for standard compliance, document retention and retention of certification and accreditation.
- Compliant delegation agreements, customer audits and compliance.
- Supports business growth and positive external business relationships through contract reviews, proposal requests, sales presentations, media communique contributions and reviews. Participates in quality customer meetings. Leads implementation of quality program for new business. Assists in product development, performance measurement development, and outcome tool selection as assigned.
- Directs assigned national and divisional projects such as HEDIS and STAR program initiatives, quality improvement outcome studies, patient safety projects, cultural competency programs and customer specific productdevelopment/enhancementactivities.
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Licensed clinician., Senior level quality professional with demonstrated experience in quality operations, accreditation achievement, and process improvement and staff supervision. Proven track record of leadership in healthcare with experience in use of Lean Six Sigma processes, auditing practices for quality control, accreditation achievement and performance measurement. Expert in data management and quality improvement study design.