Quality Assurance Contracts Manager

Agency

Dept of Health and Human Services

Division

HEALTH BENEFITS

Job Classification Title

Contract Specialist II (NS)

Position Number

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 17000 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 $65000 - $71443

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

*Position is Time-Limited for 24 months

Candidates 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 108000 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 addition paid parental leave is available to eligible employees.

Visit website forState Benefits

Supplemental and Contact Information

The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employerthat embraces an Employment First philosophy which consists of complying with all federallaws 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: 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 Governors 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.

Application Process
Be sure to complete the application in its entirety. Resumes will not be accepted in lieu of completing this application.

• Information should be provided in the appropriate areas to include the following: Education including high school and all degrees obtained Work Experience and Certificates & Licenses. It is critical to our screening and salary determination process that applications contain comprehensive candidate information.

• Answers to Supplemental Questions are not a substitute for providing all relevant information within the body of your application. To receive credit for the supplemental questions you must provide supporting information within the Work Experience section of the application to support your answers.

• If multiple applications are submitted to an individual posting only the most recent application received prior to the closing date will be must be submitted by 11:59 PM the night BEFORE the closing date.

• Applicantsmaybe subject to a criminal background check. All candidates selected for positions considered Positions of Trustwill besubject to a criminal background check.

• Due to the volume of applications received we are unable to provide information regarding the status of your application over the phone. To check the status of your application please log in to your account. Upon the closing date applications are Under Review and will be screened by Human Resources for qualified applicants. The hiring process may take several weeks.

• Degrees must be received from appropriately accredited institutions. Transcripts and degree evaluations may be uploaded with your State of North Carolina/Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.

• For a list of organizations that perform this specialized service please visit the NACES membership website at Credit Verification

  Degrees must be received from appropriately accredited institutions. Transcripts degree evaluations and cover letters may be uploaded with your application.

  Veterans and National Guard Preference

  • Applicants seeking Veterans Preference must attach aDD-214 Member-4 Form(Certificate of Release or Discharge from Active Duty) to their applications.

  • Applicants seeking National Guard Preference must attach an NGB 23A (RPAS) along with the state application if they are a current member of the NC National Guard in good standing.

  • Applicants who are former members of either the NC Army National Guard or the NC Air National Guard with honorable discharge and six years of creditable service must attach a copy of the DD 256 or NGB 22 along with the state application.

  ADA Accommodations

  Consistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA) DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment DHHS will ensure that people with disabilities or known limitations covered by the PWFA are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process please contact the person Substance Abuse Professional Practice Board etc.) indicated below.

  CONTACT INFORMATION:

  If there are any questions about this posting please contact Talent Acquisition at. Resumes will not be accepted in lieu of completing this application.

  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.

  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.

  • Bachelors 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.

  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.

  Recruiter:

  Tandrea Lanae Jones

  Email: