Project Manager EQRO

4 weeks ago

Oklahoma City, Oklahoma, United States Health Services Advisory Group Full time
Job Summary

The Project Manager will be responsible for monitoring and supporting Health Services Advisory Group's (HSAG) compliance with State external quality review (EQR) contracts. This includes compliance reviews, readiness reviews, and contributing to the development of annual technical reports and quality strategies.

Key Responsibilities
  • 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.
  • Prepare 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.
  • 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.
  • Conduct on-site or virtual compliance reviews of Medicaid managed care health plans, based on State preference.
  • 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.
  • 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.
Requirements
  • 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.
Additional Tasks
  • 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.
Compensation

$75,000 - $100,000 DOE

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