Quality Assurance Contracts Manager

State of North Carolina•1915 Health Services Way Wake, NC

6d•$65,000 - $71,443•Hybrid

About The Position

This position establishes procurement requirements for Quality Management and Compliance activity related to vendor EQRO procurement. It provides guidance to state health plan requirements related to EQRO and NCQA contract deliverables and contract management best practices. The role involves regular evaluations of Quality Assurance deliverables, identifying contract gaps or need for corrective action to advise leadership on improved contract management and oversight of Quality Assurance between EQRO, NCQA, and NC Medicaid health plans. The position serves as an SME to State Medicaid Health Plans as well as internal and external stakeholders to define the quality framework of quality improvement initiatives related to regulatory requirements of NCQA. It establishes contract monitoring systems to track progress and measure outcomes of quality improvement processes related to State Health Plan requirements for NCQA accreditation. The role conducts regular evaluations to assess the impact of implemented changes and adjust as necessary to ensure state health plan requirements are following NCQA standards and that timelines for reporting are met as defined in Health Plan contracts and oversight mechanism with EQRO vendor. The position prepares and delivers progress reports, status updates, and presentations to stakeholders and leadership. It facilitates discussions and meetings to review findings, share insights, and gather feedback on quality compliance. The role participates in continuous learning and professional development to stay updated on evidenced-based practices in healthcare quality improvement related to EQRO and NCQA compliance and activity. It oversees a team of 1-2 Quality Assurance specialists providing oversight of contractual deliverables, recommendations, and quality improvement activity to Quality Management leadership and DHB business units.

Requirements

Bachelor’s degree in business or related area from an appropriately accredited institution and four years of progressive procurement or contract administration experience; or equivalent combination of education and experience.
Completion of the North Carolina Contract Management Certification Program within one year of hire into the position.

Nice To Haves

Strong ability to communicate and guide work independently from direct supervision 90% or greater of the time.
Competent in health plan contracting standards and ability to oversee or advise on service level agreements to regulator frameworks that mitigate risks to members and the department.
Advise leadership on direct and indirect regulatory risks, anticipate new risk, and strategically advise on future contract requirements for improved oversight functions of managed care plans and fee for service contracts.
Strong understanding of Quality iterative life cycle to advise Quality Improvement leadership on future improvement initiative requirements or change needs to mitigate current or future risks, improve health outcomes, and be accountable for health plan oversight.

Responsibilities

Establishes procurement requirements for Quality Management and Compliance activity related to vendor EQRO procurement.
Provides guidance to state health plan requirements related to EQRO and NCQA contract deliverables and contract management best practices.
Conducts regular evaluations of Quality Assurance deliverables, identifying contract gaps or need for corrective action to advise leadership on improved contract management and oversight of Quality Assurance between EQRO, NCQA, and NC Medicaid health plans.
Serves as an SME to State Medicaid Health Plans as well as internal and external stakeholders to define the quality framework of quality improvement initiatives related to regulatory requirements of NCQA.
Establishes contract monitoring systems to track progress and measure outcomes of quality improvement processes related to State Health Plan requirements for NCQA accreditation.
Conducts regular evaluations to assess the impact of implemented changes and adjust as necessary to ensure state health plan requirements are following NCQA standards and that timelines for reporting are met as defined in Health Plan contracts and oversight mechanism with EQRO vendor.
Prepares and delivers progress reports, status updates, and presentations to stakeholders and leadership.
Facilitates discussions and meetings to review findings, share insights, and gather feedback on quality compliance.
Participates in continuous learning and professional development to stay updated on evidenced-based practices in healthcare quality improvement related to EQRO and NCQA compliance and activity.
Oversees a team of 1-2 Quality Assurance specialists providing oversight of contractual deliverables, recommendations, and quality improvement activity to Quality Management leadership and DHB business units.