Company: KFMC Health Improvement Partners
Job Title: Project Lead EQRO
Job Classification: Exempt, Full-Time
Schedule: Mutually determined
Location: Topeka, KS
KFMC Health Improvement Partners (KFMC) is a not-for-profit organization focused on improving healthcare quality. We inspire meaningful change and sustained high performance within the organizations and communities where we work. We’re a diverse team of multi-disciplinary professionals all focused on the same vision…best health outcomes for everyone. We believe our team members do their best work when they love what they do, and we have created an environment that fosters creativity, excellence and fun! We prioritize and value the things that are important to us, both as people and as professionals, including flexibility and a family-friendly culture. KFMC is currently seeking a Project Lead. As a member of the External Quality Review Organization (EQRO) team, this position is primarily responsible for leading the review of managed care organizations’ compliance with federal and state regulations and requirements. This role participates in project design, review activities, and writing of reports (submitted to governmental agencies and available publicly) that assess quality, timeliness, and access to care provided to members enrolled in Medicaid managed care. Graduate of an accredited college or university is required. Preference will be given to candidates with advanced degrees. Minimum of three years of experience in a health or compliance-related field is required. Knowledge/experience with managed care entities, and/or Medicaid health care delivery systems, and/or Home and Community Based Services is preferred. Excellent oral and written communication skills, and ability to manage multiple projects and activities required.
Responsible for leading and coordinating all aspects of assigned projects from development through completion, implementing Centers for Medicare and Medicaid Services’ (CMS) External Quality Review (EQR) Protocols. Works with members of State Agency customer teams, Managed Care Entities (MCEs), specific project teams, and others in the development, implementation and evaluation of various projects.
- Lead/facilitate the review of Medicaid and CHIP (Children’s Health Insurance Program) MCEs’ compliance with federal and state regulations, including documentation/case review, on-site interviews and reporting.
- Lead/facilitate and conduct other quality review projects as assigned, such as consumer surveys; review of MCE Quality Assessment Performance Improvement programs; or MCE provider network validation.
- Review studies, surveys, improvement projects and performance measurements to assess for valid and reliable results, and to assess the interpretation of results.
- Organize project teams (inclusive of programming, analytic, communication, subcontractor and other staff) in managing project(s) to completion.
- Organize team meetings using meeting agendas.
- Conduct project team meetings. Record project team meeting activities and decisions.
- Develop and maintain project-specific timelines and communicate the projected timeline to all other KFMC departments, to State Agencies, MCEs, and subcontractors as applicable.
- Provide oversight and guidance to subcontractors ensuring timely and quality products.
- Prepare and maintain all working project documentation.
- Prepare proposals, reports, updates, and summaries for all assigned projects within designated time frames.
- Prepare professionally written documents and presentations to effectively communicate compliance, study, survey, validation or monitoring results.
- Identify and develop suggestions for improvement plans and assist in developing, implementing, monitoring and tracking of improvement activities.
- Maintain the EQRO deliverables list (as assigned) taking primary responsibility for timely distribution of each required deliverable and for timely updating of deliverables list to reflect completed work.
- Lead content specific meetings with the State and MCEs; coordinate the completion and distribution of contract/stakeholder meeting minutes, as assigned.
- Assist other EQRO team members with completion of projects, as assigned.
- Keep EQRO Team informed of all activities within areas of responsibility.
- Identify opportunities for improvement in the operations of the EQRO Team.
- Share knowledge gained at conferences, seminars, etc. with other members of the team.
- Identify topics that improve the knowledge base of self and other EQRO team members and participate in LEAN.
- Use clinical and health care systems knowledge in the performance of all related tasks.
- Contribute to the achievement of organizational and work team goals by demonstrating awareness of KFMC values.
- Assist in ensuring the company’s compliance with regulatory requirements.
- Keep Supervisor and EQRO Team informed of all activities within area of responsibility.
- Other duties as assigned.
- Graduate of an accredited college or university is required. Preference will be given to candidates with advanced degrees.
- Minimum of three (3) years of experience in a health or compliance-related field is required.
- Knowledge/experience with managed care entities, and/or Medicaid health care delivery systems, and/or Home and Community Based Services is preferred.
- Knowledge/experience with program evaluation.
- Ability to accurately prepare and effectively use descriptive statistics.
- Knowledge of general research methodology and principles of epidemiology.
- Excellent organizational skills and attention to detail.
- Excellent oral and written communication skills (i.e., professional reports, public-presentation skills).
- Exceptional interpersonal communication and team-building skills.
- Ability to manage multiple projects and activities on a routine basis, with minimal supervision.
- Ability to effectively problem solve.
- Computer skills and willingness to learn software applications.
- Ability to travel.
- Ability to sit for extended periods of time.
- Ability to read computer screens and mail.
- Ability to unpack and move supplies up to 25 lbs.
- Ability to drive an automobile.
- Ability to travel as directed by position requirements.
- Professional and deadline-oriented environment in an office or remote work setting.
- Interaction with internal and external customers
Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee(s) holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by their supervisor.