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https://illinoisjoblink.illinois.gov/jobs/12211482 Job Details
With minimal direction from the executive director or director, the
Project Manager is responsible for monitoring and supporting HSAG\'s
compliance with State external quality review (EQR) contracts including
compliance reviews, readiness reviews, and contributing to the
development of annual technical reports and quality strategies through
various stages, including: Work plan and timeline development;
communications with state Medicaid agencies, project monitoring and
management; coordinating with internal teams on project timelines and
deliverables; client relations, technical assistance, and guidance;
behavioral health and physical health managed care health plan relations
and quality improvement guidance; virtual meeting organization,
distributing compliance review tools and materials, meeting
participation and logistics; report preparation and finalization. This
position is also responsible for working with and managing both internal
and external resources to achieve corporate, department, and project
goals and objectives. 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.
- Create, 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.
- Participate in external quality reviews of behavioral health,
physical health, and dental Medicaid managed care entities based on
federal and state contract requirements including, but not limited
to, assessment of performance related to compliance reviews,
performance measure reporting, and performance improvement projects
using data included in tables, charts, and graphs
- 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.
- 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.
- 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.
- Assist with developing compliance review reports, including the
collection of the documents from team members for inclusion into the
report.
- 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.
- Ot er duties as assigned.
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.
- Project deadlines may necessitate occasional extended work hours.
Compensation: 75,000 - 90,000 DOE
Job Requirements:
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, preferred.
Minimum five years of program evaluation/auditing experience in
government, hospital, pha