Medicaid Quality Assurance Lead — Compliance & EQRO

DataStaff, Inc.; Raleigh (NC); Hybrid; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k program after 6 months

Paid vacation, sick, and holiday leave

Job summary

DataStaff, Inc. seeks a Quality Assurance Manager in Raleigh, NC for a long-term contract.

The role acts as SME for quality assurance and compliance initiatives for State Medicaid Plans, liaising with EQRO and accreditation bodies, and reporting to the Senior Quality Manager. The position requires 3–5 years in healthcare quality/compliance with CMS/Medicaid experience; strong project management and cross-functional collaboration skills are essential.

Qualifications

• Bachelor's degree in Public Health, Healthcare Administration, Public Policy, or related field.
• 3–5 years of professional experience in healthcare quality, compliance, contracting, or related areas.
• Experience with Medicaid programs, CMS regulations, managed care quality structures, and state health plan compliance.
• Experience collaborating with EQROs or accreditation organizations (NCQA, URAC, Joint Commission).
• Knowledge of CMS requirements, EQRO protocols, and Medicaid quality regulations.
• Proven project management skills with ability to manage multiple deliverables and meet timelines.

Responsibilities

• Establish monitoring systems to track progress and outcomes of quality and compliance processes.
• Provide guidance to State Health Plans on EQRO processes and quality contract deliverables.
• Evaluate impact of changes to ensure CMS, EQRO, and State Health Plan compliance.
• Translate regulatory guidance into operational expectations, workflows, and measurable deliverables.
• Analyze data trends, identify gaps, and recommend improvements.
• Prepare progress reports and presentations to stakeholders and leadership.
• Facilitate discussions to review findings and gather feedback.
• Manage multiple priorities and deadlines.
• Build relationships with EQRO reviewers and accreditation bodies.
• Stay updated on evidence-based practices in healthcare quality improvement.

Skills

CMS regulations

EQRO/Accreditation

Project management

Regulatory compliance

Stakeholder communication

Data analysis

Healthcare quality

Education

Bachelor's degree in Public Health or related field

Master's degree in Public Health / Healthcare Administration

Job description

DataStaff, Inc. seeks a Quality Assurance Manager in Raleigh, NC for a long-term contract.

The role acts as SME for quality assurance and compliance initiatives for State Medicaid Plans, liaising with EQRO and accreditation bodies, and reporting to the Senior Quality Manager. The position requires 3–5 years in healthcare quality/compliance with CMS/Medicaid experience; strong project management and cross-functional collaboration skills are essential.