Summary

The Project Manager role is responsible for conducting annual Medicaid and 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. The Project Manager is also 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 tools and materials.
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.
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.
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.
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 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 government, hospital, 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 practices.
Proficient in Windows environment specifically Outlook, Word, and Excel.
Works well in a remote team environment and independently.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, work load, rush jobs requiring non-regular work hours, or technological developments).

HSAG is an EEO Employer of Veterans protected under Section 4212.

If you have special needs and require assistance completing our employment application process, please feel free to contact us.

EOE M/F/Vet/Disability

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