EQR PROGRAM MANAGER (External Quality Review)
Little Rock, AR
General Purpose of Position:
Requires three years of External Quality Review (EQR) experience. Responsible for coordination of all contract deliverables and collaboration with state and other contract stakeholders. Manages EQRO team members and provides guidance and support to health plans and the State regarding quality improvement plan development, implementation, measurement, and evaluation. Supports other functional areas of the organization as directed and performs other duties as assigned. This position is based in Little Rock, AR and reports to the EQRO Director.
Major Duties and Responsibilities:
Knowledge, Skills and Attributes:
- Develop quality assessment tools and conduct compliance reviews including but not limited to; scheduling, pre-assessment documentation review, onsite review activities and report preparation.
- Responsible for managing and evaluating EQR team members.
- Develop, maintain and monitor quality assurance in all EQR communication, deliverables and activities.
- Conduct PIP validations.
- In addition to EQRO Director, serves as main point of contact via written, telephonic and faceto-face interaction with the state in matters related to contract deliverables.
- Provide technical assistance and training to managed care organizations and State.
- Coordinates and conducts quality studies including medical record review.
- Coordinate all EQR activities with the designated State EQRO contact throughout the design, development, and finalization of all technical reports and other deliverables. Participate in regular meetings or as often as requested by State either via phone, video conference, or on site at State offices. The purpose of these regular meetings is to maintain communication with the State-designated EQRO contact to discuss progress, barriers, and any other related issues relevant to the EQR activities.
- Designate appropriate staff to meet with State program staff to provide clarification or direction in relation to EQR projects.
- Facilitate meetings to include: providing an agenda, minute taking, and creation and distribution of informational materials.
- Facilitate and prepare oral presentation of EQR findings, recommendations, corrective action plans, and technical assistance to State program staff.
- Ensure all final technical reports and other deliverables are timely, well written, accurate, and complete.
- Assist State in responding to any questions from CMS or other stakeholders about any final technical reports or deliverables.
- Prepare and deliver Contractor activity reports to State, including any due dates, milestones, and project status.
- Willingness to travel approximately 30 percent.
Education and Experience:
- Knowledge of CMS EQR protocols.
- Strong customer-service orientation, both internally and externally.
- Strong team leadership, quality improvement experience and project management skills.
- Ability to work on multiple projects simultaneously, and ability to effectively deal with changes in project requirements.
- Attention to detail.
- Ability to work in a team environment while possessing strong self-directed capabilities.
- Excellent written & verbal communication skills.
- Educational presentations skills.
- Basic computer skills (Word, Excel, PowerPoint, Access, Outlook).
- Takes the initiative to remain current with relevant clinical topics and managed care performance improvement issues.
- Advanced degree/Masters level required.
- Minimum of 3 years EQR experience.
- Minimum 5 years management experience.
- Experience in managed care, health care quality improvement, and project management.
- Knowledge and understanding of NCQA Accreditation and HEDIS.
- CPHQ or interest in pursuing preferred.