Project Manager EQRO - IA, MI, NV

3 hours, 5 minutes ago
Full-time
Senior
Quality Assurance and Testing
Health Services Advisory Group

Health Services Advisory Group

HSAG is a quality improvement organization that enhances healthcare quality for Medicare and Medicaid beneficiaries through reviews and interventions.

Health Care Providers & Services
251-1K
Founded 1979

Description

  • Manage day-to-day contracted external quality review activities.
  • Develop and maintain project work plans, timelines, documentation, and deliverables.
  • Coordinate communications and follow-up with state Medicaid agencies, health plans, project partners, subcontractors, and internal teams.
  • Create, distribute, and collect compliance and readiness review tools and materials.
  • Prepare audit packets and coordinate health plan document submissions for desk reviews.
  • Conduct onsite or virtual compliance reviews of Medicaid managed care health plans as part of an audit team.
  • Collect, analyze, and report project data and assist with audit and annual EQR technical reports.
  • Research and apply state contract requirements, CMS rules, and state regulations.
  • Identify process improvement opportunities and support quality improvement activities.
  • Monitor internal and external information portals, including FTP and SharePoint sites.

Requirements

  • Bachelor’s degree in a health-related field, or a non-healthcare bachelor’s degree plus five years of Medicaid managed care compliance experience.
  • Master’s degree in a health-related field preferred.
  • At least five years of program evaluation or auditing experience in a health plan, state Medicaid agency, or healthcare organization.
  • Experience with Medicaid and/or dual-eligible Medicaid/Medicare managed care.
  • Knowledge of quality improvement, utilization management, and/or care management practices.
  • Excellent oral, written, and interpersonal communication skills.
  • Strong organizational and time-management abilities.
  • Proficiency with Windows, Outlook, Word, and Excel.
  • Ability to work independently and effectively in a remote team environment.
  • Willingness to travel for onsite reviews and work atypical schedules when required by time-zone differences; occasional extended hours may be necessary.

Interested in this position?

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