Summary

The Project Manager role is responsible for conducting annual Medicaid compliance reviews and readiness reviews, and contributing to the development of the annual external quality review (EQR) technical reports. The Project Manager role also provides ongoing project management and support for the contracted EQR and EQR-related activities, including developing and managing work plans and timelines; communicating with State Medicaid agency, health plan, and internal staff members, and ensuring follow-up as necessary; creating and distributing compliance review tools and materials; and preparing and finalizing compliance, readiness review, and technical reports. This position is additionally responsible for working with and managing both internal and external resources to achieve corporate, department, and project goals and objectives. Further, the Project Manager is responsible for monitoring and supporting HSAG’s compliance with its State EQRO contracts.

Essential Competencies, Duties, and Responsibilities

• Provide day-to-day project management and support of contracted EQR activities.
• Develop, 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 and readiness review tools and materials.
• Prepare audit packets 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.
• As part of an audit 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.
• Assist with the development, collection, analysis, and reporting of data.
• Assist with developing audit reports, including the collection of the documents from team members for inclusion into the report.
• Assist with the development of the annual EQR technical reports.
• 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.

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.
• Coordinate and assist with EQR related work, as assigned.
• 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.

Education and/or Experience

• 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 at a health plan or State Medicaid agency will be considered. Master’s degree in a health-related field is preferred.
• Medicaid and/or dual-eligible (Medicaid/Medicare) managed care experience.
• Minimum five years of program evaluation/auditing experience in health plan, state Medicaid agency, or other healthcare related field.

Other Qualifications

• Excellent oral and written communication skills.
• Excellent interpersonal skills.
• Organizational and time-management skills.
• Experience and knowledge of quality improvement, utilization management, and/or care management practices.
• Proficient in Windows environment specifically Outlook, Word, and Excel.
• Works well in a remote team environment and independently.