Quality Assurance Contracts Manager

nc; North Carolina; Hybrid; USD 65,000 - 71,000; Full time

Benefits offered by this job

Hybrid work option

Job summary

The North Carolina Department of Health and Human Services (DHHS) seeks a Contract Specialist II (NS) to establish procurement requirements for Quality Management and Compliance, focusing on EQRO procurement and NCQA contract governance.

You will evaluate QA deliverables, monitor contracts with EQRO, NCQA, and Medicaid health plans, and advise leadership on regulatory risks and corrective actions. A hybrid work arrangement is available for this role.

Qualifications

• Strong ability to communicate and guide work independently from direct supervision.
• Competent in health plan contracting standards and SLAs with regulators.
• Advise leadership on regulatory risks and future contract requirements.

Responsibilities

• Establish procurement requirements for Quality Management and Compliance activity related to vendor EQRO procurement.
• Provide guidance on NCQA contract deliverables and contract management best practices.
• Evaluate Quality Assurance deliverables and identify contract gaps for leadership action.
• Serve as SME to State Medicaid Health Plans and stakeholders to define quality framework for regulatory requirements.
• Establish contract monitoring systems to track progress and measure outcomes.
• Prepare and deliver progress reports and presentations to stakeholders and leadership.
• Oversee a team of Quality Assurance specialists providing oversight of contractual deliverables.

Skills

Quality management

Contract management

NCQA standards

Stakeholder communication

Job description

Contract Specialist II (NS)

Agency Dept of Health and Human Services Division HEALTH BENEFITS

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

• This position 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.
• 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
• 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