External Quality Review Contract Manager

3 days ago

Raleigh, North Carolina, United States The Carolinas Center for Medical Excellence Full time
Job Title: External Quality Review Contract Manager

We are seeking a highly skilled External Quality Review Contract Manager to join our team at Constellation Quality Health. As a key member of our organization, you will be responsible for the effective and efficient operation of assigned contracts and services.

Key Responsibilities:

  • Oversee and coordinate all contract/business activities, ensuring customer deliverables are met and of the highest quality.
  • Develop, train, and cross-train contract staff; monitor productivity, schedules, volume, quality and accuracy of end products and reports, timeliness of deliverables; and address performance issues as needed.
  • Act as primary contact, meeting facilitator, and resource for contractual questions/discussions.
  • Analyze program systems and processes to identify opportunities for efficiencies and develop solutions.
  • Develop and manage budgets.
  • Provide subject matter expertise for service line proposals.

Requirements:

  • Bachelor's degree required; Master's degree preferred; ten (10) years of related experience
  • CPHQ or other advanced certification (Project Management, HEDIS, Utilization Management, etc.) required
  • Five (5) years' experience in related contract work and/or quality management in a leadership capacity.
  • Minimum five (5) years of supervisory experience, managing diverse teams
  • Experience managing and utilizing data to identify risks, trends, gaps, and opportunities
  • Knowledge of MCO and/or PIHP delivery systems and current trends
  • Experience with Medicaid populations, programs, and policies
  • Experience with Medicaid managed care
  • Excellent communication skills to include developing training materials, website postings, and newsletter outlines
  • Experience in Quality Management and Performance Improvement methodologies
  • Experience writing professional reports
  • Experience with Utilization Management, Case Management, Managed Care networks, Claims/Appeals, and/or Population Health
  • Knowledge of URAC and/or NCQA accreditation standards or certification a plus
  • Excellent communication skills, both written and oral
  • Experience making professional presentations to large audiences
  • Ability to function independently and coordinate review activities
  • Proficiency with Microsoft Office Products, including Word, PPT, Excel, etc.

About Constellation Quality Health:

We offer a competitive salary and benefits package and a flexible, supportive hybrid work environment.

Equal opportunity employer of protected veterans

Equal opportunity employer of individuals with disabilities

We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.

Applicants and employees are protected from discrimination based on inquiring about, disclosing, or discussing compensation or the compensation of other applicants or employees.

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