External Quality Review (EQR) Contract Manager - The Carolinas Center for Medical Excellence

External Quality Review (EQR) Contract Manager

Remote Employment

Who We Are:

Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolina’s Research Triangle, we offer an array of quality improvement, clinical review, audit, technical, and consulting services and solutions to improve care delivery, system performance, and patient outcomes.

What You’ll Do:

We are seeking an External Quality Review (EQR) Contract Manager to be responsible for the effective and efficient operation of assigned contracts and services. This position plays a key role assisting with identification and capitalizing on business opportunities and providing maximum value to the customer!

We expect you to:

• Serve as a leader and professional role model to support Constellation Quality Health’s drive into the future.
• Oversee and coordinate all contract/business activities, ensuring customer deliverables are met and of the highest quality.
• Develop, train, and cross-train contract staff; monitor productivity, schedules, volume, quality and accuracy of end products and reports, timeliness of deliverables; and address performance issues as needed.
• Act as primary contact, meeting facilitator, and resource for contractual questions/discussions.
• Analyze program systems and processes to identify opportunities for efficiencies and develop solutions.
• Develop and manage budgets.
• Provide subject matter expertise for service line proposals.

This is a remote work opportunity for the right candidate!

Who You Are:

The successful incumbent candidate will be a leader who maintains professional working relationships with health plans, state Medicaid agency contract staff and program leaders, and all internal and external customers. This management position will proactively identify and assist with the development of plans and activities to expand EQR contract opportunities; and provide maximum value to the customers. Responsibilities include monitoring contract performance, identifying future business opportunities, developing process improvements and enhancements, and establishing operational workflows and procedures for the EQR service line.

Our requirements for this role:

• Bachelor’s degree required; Master’s degree preferred; ten (10) years of related experience
• CPHQ or other advanced certification (Project Management, HEDIS, Utilization Management, etc.) required
• Five (5) years’ experience in related contract work and/or quality management in a leadership capacity.
• Minimum five (5) years of supervisory experience, managing diverse teams
• Experience managing and utilizing data to identify risks, trends, gaps, and opportunities
• Knowledge of MCO and/or PIHP delivery systems and current trends
• Experience with Medicaid populations, programs, and policies
• Experience with Medicaid managed care
• Excellent communication skills to include developing training materials, website postings, and newsletter outlines
• Experience in Quality Management and Performance Improvement methodologies
• Experience writing professional reports
• Experience with Utilization Management, Case Management, Managed Care networks, Claims/Appeals, and/or Population Health
• Knowledge of URAC and/or NCQA accreditation standards or certification a plus
• Excellent communication skills, both written and oral
• Experience making professional presentations to large audiences
• Ability to function independently and coordinate review activities
• Proficiency with Microsoft Office Products, including Word, PPT, Excel, etc.

Why Constellation Quality Health?

We offer a competitive salary and benefits package and a flexible, supportive hybrid work environment.

Equal opportunity employer of protected veterans

Equal opportunity employer of individuals with disabilities

We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.

Applicants and employees are protected from discrimination based on inquiring about, disclosing, or discussing compensation or the compensation of other applicants or employees.