Quality Specialist (Critical Incident Reporting) - Albuquerque, NM

• Takes immediate action to assure the member is protected from further harm and responds to any emergency needs of the member, upon notification of a critical incident.
• Reviews the Pre-Manage report daily to identify member access to emergency services and submits CIRs on behalf of members who meet criteria for reporting onto the HCA portal.
• Receives CIRs on an internal electronic form from Behavioral Health Care Coordinators (BH CC), BH Peer Support Workers (BH PSWs), and BH Community Health Workers (BH CHWs).
• Submits CIRs on behalf of BH CC, BH PSWs, and BH CHWs.
• Makes outreach to providers to educate on the correct CIR submission route when they have submitted a CIR via fax; however, meets criteria for reporting on the HCA portal.
• Makes outreach to providers to follow-up on critical incidents and documents the follow-up in the CIR Diary Entry.
• Makes outreach to Care Coordinators to request follow-up on the member and documents the follow-up in the CIR Diary Entry.
• Documents follow-up in the CIR Diary Entry that includes information regarding the health and safety needs of the member that have been met.
• Documents incident follow-up on the HCA portal utilizing the Diary Entry function to include the health and safety needs of the member that have been met.
• Documents actions initiated and follow-up activities related to interventions implemented as a result of the incident into the HCA Portal until the established intervention(s) demonstrate the member’s health, safety, and welfare are no longer issues of concern.

Independently performs quality functions within the Quality Department of a Care Center or office. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes and reported outcomes.

• Coordinates assigned quality and process improvement activities which may include accreditation support, process improvement projects and monitoring of performance guarantees.
• Conducts quality control reviews and internal audits.
• Summarizes findings and prepare reports on findings.
• Assists in the preparation of customer and external audits.

Other Job Requirements

Responsibilities

Up to 2 years of quality improvement and auditing or related in healthcare field.
Knowledge of healthcare quality improvement processes and performance measurement.
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.

General Job Information

Title

Quality Specialist (Critical Incident Reporting) - Albuquerque, NM

Grade

22

Work Experience - Required

Quality

Work Experience - Preferred

Education - Required

Education - Preferred

Bachelor's - Healthcare

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$50,225

Salary Maximum:

$75,335

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

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.