Remote | Full-Time

Job Details

Summary

This full-time Project Manager (PM) provides ongoing project management and general support to contracted external quality review (EQR) activities, including developing and managing workplans and timelines, organizing and conducting project work, and ensuring follow-up, as necessary. Primary responsibilities include projects focused on compliance with federal and state regulations, mental health parity, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), quality of care concerns, grievances, appeals, denials, and utilization management. The PM will participate in the creation and distribution of audit tools and materials, conducting desk reviews, health plan interviews, and coordinating report preparation and finalization, including preparation of the annual EQR technical report. The PM will interact with internal and external resources (including State Medicaid agencies, health plans, and stakeholder groups) to achieve corporate, department, and activity goals and objectives. The PM plays a critical role in monitoring and supporting HSAG’s compliance with State EQRO contracts.

Essential Competencies and Responsibilities

• Provide day-to-day project management and support of contracted EQR activities.
• Develop, coordinate, and manage project workplans and timelines for assigned contracts and EQR activities.
• Preparation of project documentation related to key deliverables and supporting documentation for assigned contracts and EQR activities.
• Conducts research into federal and state requirements, Senate bills, CMS waivers (E.g., 1915(b) and 1115), and clinical literature reviews associated with recommended improvements in the states’ quality strategies.
• Participates in EQR projects, including project development, initiation, policy and procedure review, health plan interviews, debriefs with the State, and report writing.
• Ensures timely and accurate completion of assigned tasks.
• Collaborates with HSAG staff members to efficiently evaluate and manage the workload as assigned within budget scope and allocated timeframes.
• Represent HSAG in a professional manner, at all times.

Essential Duties and Tasks

• Assists in writing annual EQR Technical Reports.
• As part of the compliance review team:
• Conducts compliance interviews of Medicaid managed care plans, interfacing directly with health plan and state leadership.
• Manages the corrective action plan process for the health plans after the completion of compliance reviews and quality studies.
• Conducts review of policies, procedures, clinical records, and case management records.
• Leads or co-leads health plan interviews in a virtual or in-person setting.
• Provides technical assistance to subcontractors and health plans.
• Leads clinical and non-clinical quality studies and drafts reports to include findings and recommendations for improvement. Interacts with contracted clinical staff, physician consultant, and state stakeholders to develop clinical studies and consults with them as needed for day-to-day activities.
• Assists with other tasks as assigned.

Job Requirements

Education and/or Experience

• Bachelor’s degree required, preferably in a health care related field.
• Two to five years project management experience.

Other Qualifications

• Excellent oral and written communication and interpersonal skills.
• Excellent interpersonal skills; ability to interact collaboratively with internal team members and professionally with external partners.
• Excellent organizational and time-management skills.
• Experience and knowledge of quality improvement processes and practices.
• Experience and knowledge of Medicaid managed care health plans and state operations.
• Ability to adhere to established activity timelines.
• Proficiency with Windows environment specifically Word, Excel, PowerPoint, Outlook, Teams, and SharePoint.
• Works well in a remote team environment and independently.

Work Environment

This is a home-based position with occasional travel to conduct in-person meetings and audits in support of assigned contacts and projects. 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. Project deadlines may necessitate occasional extended work hours, including weekends.

HSAG All User Information Security Responsibilities

All workforce members, volunteers, contractors or third-party agents of HSAG, Inc. who are authorized to access information systems and/or associated company data on paper or in electronic format are responsible for the following: 

• Adhering to policies, procedures and guidelines pertaining to the protection of HSAG Company Data.
• Reporting actual or suspected breaches or vulnerabilities in the confidentiality, integrity or availability of HSAG Data to your immediate supervisor/manager, Corporate Compliance or Information Technology/Security Personnel. 
• Reporting actual or suspected breaches or vulnerabilities in confidentiality, integrity or availability of Corporate Data, may be reported anonymously, via the NAVEX Global Compliance hotline at 1-800-992-9892.

HSAG publishes various policies, guidelines and procedures related to the protection of Corporate Data and Information Systems. They can be found on the corporate SharePoint website. Information on requirements that may be unique to your business unit or a system you have access to can be found by talking to your supervisor/manager or designated system administrator.

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