Project Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform annual reviews for Medicaid compliance and readiness assessments.

• Contribute to the technical reports for the annual external quality review (EQR).

• Manage day-to-day project operations and support for contracted EQR initiatives.

• Develop, coordinate, and oversee project work plans and timelines.

• Engage with State Medicaid agencies, health plans, internal teams, project partners, clients, subcontractors, and various entities.

• Prepare essential project documentation and key deliverables support documents.

• Identify areas for enhancement in project processes and promote quality improvement initiatives.

• Create, distribute, and manage compliance review and readiness review tools and resources.

• Assemble audit packets, including materials for onsite or virtual document reviews.

• Coordinate submissions of health plan documents for desk reviews.

• Conduct onsite or virtual compliance evaluations of Medicaid managed care health plans.

• Assist in the development, collection, analysis, and reporting of relevant data.

• Aid in the creation of audit reports and compilation of documents from team members.

• Support the preparation of annual EQR technical reports.

• Research, interpret, and apply state contract stipulations, CMS regulations, and state guidelines.

• Monitor and manage EQRO information portals, including FTP and SharePoint sites.

• Coordinate project tasks and facilitate communications.

• Uphold communication protocols for State, health plans, and corporate stakeholders.

• Assist with EQR-related activities as assigned.

• Oversee and support HSAG’s adherence to State EQRO contracts.

⛳️ Requirements

• Bachelor’s degree in a health-related discipline, or a non-healthcare related bachelor’s degree with five years of experience in Medicaid managed care compliance at a health plan or State Medicaid agency.

• Experience in Medicaid and/or dual-eligible (Medicaid/Medicare) managed care.

• At least five years of program evaluation or auditing experience in a health plan, state Medicaid agency, or related healthcare field.

• Exceptional oral and written communication abilities.

• Strong interpersonal skills.

• Effective organizational and time-management capabilities.

• Familiarity with quality improvement, utilization management, and/or care management practices.

• Proficient in the Windows environment, particularly with Outlook, Word, and Excel.

• Ability to thrive in a remote team setting as well as independently.

• Onsite compliance reviews will necessitate travel.

• Flexibility to accommodate atypical work hours due to time zone differences and occasional extended hours.

🏝️ Benefits

• Full-time exempt salaried position.

• Option for remote work.

• Reasonable accommodations provided for individuals with disabilities.

• Equal Employment Opportunity protections for veterans, minorities, women, and individuals with disabilities.