Quality Assurance Contracts Manager

Health & Human Services; North Carolina; Hybrid; USD 65,000 - 71,000; Full time

Job summary

Health & Human Services in North Carolina is seeking a Contract Specialist II to manage EQRO/NCQA contracts, oversee quality assurance deliverables, and guide health plan oversight for regulatory compliance.

The role involves leading contract monitoring, reporting to leadership, and coordinating with internal and external stakeholders to ensure timely and compliant contract performance. Hybrid work options are available for this time-limited 24-month assignment.

Qualifications

• Bachelor’s degree in business or related area from an appropriately accredited institution and four years of progressive procurement or contract administration experience.
• Completion of the North Carolina Contract Management Certification Program within one year of hire into the position.
• Understanding of EQRO/NCQA requirements and regulatory frameworks.

Responsibilities

• Provide guidance to state health plan requirements related to EQRO and NCQA contract deliverables and contract management best practices.
• Conduct regular evaluations of Quality Assurance deliverables, identifying contract gaps or need for corrective action.
• Serve as SME to State Medicaid Health Plans and stakeholders to define the quality framework of quality improvement initiatives.
• Establish contract monitoring systems to track progress and measure outcomes of quality improvement processes.
• Prepare and deliver progress reports and presentations to stakeholders and leadership.

Skills

Communication

Contracting standards

Regulatory risk

Quality improvement

Education

Bachelor's degree in business or related area

Contract Management Certification

Job description

Agency Dept of Health and Human Services Division HEALTH BENEFITS

Job Classification Title Contract Specialist II (NS) Position Number 65029353 Grade NC17

About Us

The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.

Description of Work

• Provides guidance to state health plan requirements related to EQRO and NCQA contract deliverables and contract management best practices.
• Conduct 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.
• Establish contract monitoring systems to track progress and measure outcomes of quality improvement processes related to State Health Plan requirements for NCQA accreditation.
• Conduct 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.
• Prepare and deliver progress reports, status updates, and presentations to stakeholders and leadership.
• Facilitate discussions and meetings to review findings, share insights, and gather feedback on quality compliance.
• Participate 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.

Knowledge, Skills and Abilities/Management Preferences

Recruitment Range $65,000 - $71,443

Position is eligible for a hybrid-teleworking schedule to include weekly onsite work hours

*Position is Time-Limited for 24 months

Applicants now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement. The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:

• 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.

Physical Requirements: Standard office work include standing and sitting, typing, and travel.

Posting closes at 11:59 p.m. the night before the closing date. Position is funded in part through federal funds.

About the NC Division of Health Benefits

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.

Compensation & Benefits

The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees.

Visit website for State Benefits Supplemental and Contact Information

Equal Opportunity Statement

The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federal laws, state laws, and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: https://www.ncdhhs.gov/.

DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position. In accordance with the Governor’s Executive Order 303, our agency supports second-chance employment for individuals who were previously incarcerated or justice-involved. We invite all potential applicants to apply for positions for which they may be qualified.

Minimum Education and Experience

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.

Necessary Special Requirements Completion of the North Carolina Contract Management Certification Program within one year of hire into the position.

Minimum Education and Experience Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details.

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

Additional Information

All job postings close at 11:59pm the night before the End Date on the posting.