Quality Assurance Manager

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 is seeking a Quality Assurance Manager for a long-term contract opportunity with one of our direct clients located in Raleigh, NC

*This role is hybrid; 2 days a week will be onsite

Position Description

The Quality Assurance Manager acts as the SME for activities related to quality assurance and compliance initiatives for State Medicaid Plans. The Quality Assurance Manager supports the State's compliance with federal and state quality standards. Specifically, this position serves as the liaison to the External Quality Review Organization (EQRO) and accreditation organizations. This contract position reports to the Senior Quality Manager for deliverables.

Job Responsibilities:

• Establish monitoring systems to track progress and measure outcomes of quality and compliance processes across cross-functional teams.
• Provide guidance to State Health Plans on requirements related to EQRO processes and quality contract deliverables.
• Conduct regular evaluations to assess the impact of changes and adjust processes as necessary to ensure compliance with CMS, EQRO, and State Health Plan requirements and reporting timelines.
• Applies in-depth knowledge of CMS regulations, EQRO protocols, accreditation standards, and federal/state Medicaid quality requirements to guide quality assurance activities and ensure the accuracy and completeness of required deliverables.
• Interprets complex regulatory guidance and translates it into operational expectations, workflows, and measurable deliverables for health plans and internal teams.
• Utilizes analytical skills to evaluate data trends, identify gaps, assess performance risks, and recommend improvements.
• Prepares and delivers detailed progress reports, status updates, and presentations to stakeholders and leadership.
• Facilitates discussions and meetings to review findings, share insights, and gather feedback on quality compliance processes.
• Manages multiple priorities and deliverables while ensuring all deadlines and reporting timelines are met.
• Builds effective working relationships with EQRO reviewers, accreditation bodies, health plan representatives, and internal teams to support coordinated quality improvement efforts.
• Engages in continuous learning and professional development to stay updated on evidence-based practices in healthcare quality improvement related to EQRO and accreditation compliance and activities.

Required Qualifications

• Bachelor's degree in Public Health, Healthcare Administration, Public Policy, or a related field.
• Minimum of 3 -5 years of professional experience in healthcare quality, compliance, contracting, or related areas.
• Demonstrated experience working 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).
• Applied working knowledge of CMS requirements, EQRO protocols, and federal/state Medicaid quality regulations.
• Proven project management skills with the ability to manage multiple deliverables and meet strict timelines.

Preferred Qualifications

• Master's degree in Public Health, Business Administration, Healthcare Administration, or a related field.
• Certification in healthcare quality (such as CPHQ).
• Certifications in project management (such as PMP)
• Prior experience with state government operations, Medicaid managed care organizations, or accreditation compliance structures.

This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.