Company: KFMC Health Improvement Partners
Position: Quality Review Project Lead
Job Classification: Exempt, Full-time
Pay Range: $63,000.00-$79,500.00/yr, based on experience
Work Schedule: Mutually Determined
Reports to: EQRO Senior Manager
Location: Topeka, KS (on-site). This can be a hybrid or in-office position; would need to be located in the Topeka area.

KFMC employs 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 Quality Review Project Lead. As a member of the External Quality Review Organization (EQRO) team, this position is primarily responsible for leading the evaluation of Performance Improvement Projects conducted by managed care entities. This role participates in project design, review activities, and writing of reports (submitted to governmental agencies and available publicly) that assess quality, timeliness of, 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’ experience with project management or program evaluation required, as well as one or more of the following: qualitative and/or quantitative research methods, quality/process improvement, descriptive statistics, and analysis. Candidates must have excellent skills in oral and written communication, time management, and ability to manage multiple projects.

Primary Accountability:
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; compiles findings into reports ensuring compliance with CMS guidelines, State requirements, and other managed care policies. Possible projects include performance improvement project validation and technical assistance, performance measure validation, and review of policies and procedures for compliance with requirements and regulations. Analyzes quality improvement processes and conducts research to identify trends, key indicators, patterns, and insights. Liaises between project members, cross-functional teams, external vendors, and other stakeholders to ensure deliverables, requirements, schedules, and meeting plans are communicated. Utilizes appropriate tools to plan project timelines, tasks, milestones, and deadlines.

Major Duties:

• Lead/facilitate the evaluation of the overall validity, reliability, and effectiveness of MCE Performance Improvement Projects (PIPs), including the assessment of PIP results and MCE interpretations, review of data and technical specifications, and compiling results into professional reports.
• Provide technical assistance to MCEs and State partners throughout the MCE PIP process, as well as in the development of methodologies, including measures and interventions.
• Lead/facilitate the review of MCE compliance with federal and state regulations, including documentation review, clinical case review, performance measure validation, and reporting.
• Lead/facilitate and conduct other quality review projects as assigned, such as the review of 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 and 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, 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 evaluation, study, survey, or validation results.
• 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 and implement continuous process improvement (e.g., Lean, PDSA).
• 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.
• 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..

Qualifications:

Required:

• Graduate of an accredited college or university is required. Preference will be given to candidates with advanced degrees.
• Minimum of three (3) years’ experience with project management or program evaluation required.
• Experience with one or more of the following required: qualitative and/or quantitative research methods, quality/process improvement, descriptive statistics, and analysis.
• Excellent organizational and time management skills required, as well as excellent attention to detail.
• Excellent oral and written communication skills (e.g., report writing, meeting facilitation).
• Ability to manage multiple projects and activities on a routine basis, with minimal supervision.
• Ability to effectively problem solve.
• Exceptional interpersonal communication and team-building skills.
• Computer skills and willingness to learn software applications.
• Ability to travel.
• Must be located in the United States.

Preferred

• College Major or Minor in the sciences, public health, epidemiology, healthcare administration, statistics, or health informatics preferred.
• Knowledge/experience with managed care entities, and/or Medicaid health care delivery systems, and/or Home and Community Based Services is preferred.

Physical Demands:

• 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

Work Environment:

• Professional and deadline-oriented environment in an office setting.
• Interaction with internal and external customers.

Additional Duties:
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.