Project Manager EQRO - REMOTE - 1103/752/3909_7-3819

at Health Services Advisory Group, Inc. in Springfield, Illinois, United States

Job Description

• Provide day-to-day project management and support of contracted EQR activities.
• Create, coordinate, and manage project work plans and timelines for the various EQR activities.
• Preparation of project documentation related to key deliverables and support documentation for assigned contracts and projects.
• Identify opportunities to improve project processes and procedures, and support quality improvement activities accordingly.
• Assist with the creation, distribution, and receipt of compliance review tools and materials.
• Participate in external quality reviews of behavioral health, physical health, and dental Medicaid managed care entities based on federal and state contract requirements including, but not limited to, assessment of performance related to compliance reviews, performance measure reporting, and performance improvement projects using data included in tables, charts, and graphs
• Prepare packets for compliance review documents for delivery to the health plans, including preparation of onsite/virtual document review packets.
• Coordinate the submission of documents from health plans for desk review.
• Conduct desk review of documents received from health plans or similar organizations to prepare for audits.
• As part of a compliance review team, conduct on-site or virtual compliance reviews of Medicaid managed care health plans, based on State preference. Of note, onsite compliance reviews will require travel and onsite and virtual compliance reviews will result in atypical work schedules due to time zone differences.
• Conduct record review activities, such as denials, grievance, appeals, credentialing and waiver and non-waiver case management reviews.
• Assist with the development, collection, analysis, and reporting of data.
• Assist with developing compliance review reports, including the collection of the documents from team members for inclusion into the report.
• Write reports, validate report data, and conducts quality checks on reports and spreadsheets.
• Assist with the development of the annual EQR technical reports.
• Takes notes during meetings and disseminates notes to all participants.
• Research, interpret and apply state contract requirements.
• Research, interpret and apply the Centers for Medicare & Medicaid Services (CMS) and state rules and regulations to EQR work.
• Research, interpret and apply CMS EQR protocols.
• Other duties as assigned.

• Monitor and maintain EQRO external and internal information portals, including FTP and SharePoint sites.
• Coordinate project tasks including communication (i.e., written, electronic, phone).
• Maintain State, health plan, and corporate communication protocol.
• Prepare and deliver monthly progress reports to State contacts.
• Coordinate and assist with EQR related work, as assigned.
• Assist with the development, collection, analysis, and reporting of data.
• Communicate with project partners, clients, subcontractors, and other entities at the direction of the Director/Executive Director.
• Project deadlines may necessitate occasional extended work hours.

• Bachelor's degree in a health-related field, or a non-healthcare related bachelor's degree and five years of experience in Medicaid managed care compliance will be considered. Master's degree in a health-related field is preferred.
• Medicaid and/or dual-eligible (Medicaid/Medicare) managed care experience, preferred.
• Minimum five years of program evaluation/auditing experience in government, hospital, pharmaceutical, immunization, behavioral health, health plan, state Medicaid agency or other healthcare related field.

• Excellent oral, written, and interpersonal communication skills.
• Excellent English language skills.
• Ability to rapidly adjust priorities, work to imminent deadlines, and apply multi-tasking skills to coordinate projects with overlapping and/or simultaneously occurring timelines
• Organizational and time-management skills.
• Experience and knowledge of quality improvement practices.
• Knowledge of Medicaid and health care delivery systems preferred.
• Proficient in Windows environment specifically Outlook, Word, PowerPoint, and Excel.
• Works well in a remote team environment and independently.
• Effective and positive human relations skills including the ability to maintain confidentiality, to appropriately interface with all levels of Health Services Advisory Group administration/staff and clients.
• Professional demeanor and excellent judgment.
• Proficiency with hosting and navigating online conferencing such as Webex and Teams meetings.