| Description: | Provides consultation to the Office Chief and staff of the Office of Quality and Care Management on policies and standards related to managed care quality, physician quality and incentive arrangements, and critical measures of population-based quality of care. Plans and conducts training and education on managed care quality. Writes and oversees others writtenreports on quality of care measurement. Manage External Quality Review contract with an External Quality Review Organization. Oversee statewide health care quality improvement measurement and improvement projects within the Quality Management section to assure that Medicaid/SCHIP clients enrolled in managed care have appropriate access to high quality health care. Collaborate with internal stakeholders such as HRSA contract managers and senior leadership to provide information and support for measurement and improvement activities. Collaborate and gain support of external stakeholders such as the Washington State Department of Health, State Board of Health, Health Plan quality improvement managers, medical leaders (e.g., American Academy of Pediatrics, National Initiative for Children's Healthcare Quality and
community stakeholders to implement projects aimed at improving health care for the populations served by the Medicaid/SCHIP program. Participate in inter-agency quality monitoring and compliance team. Ensure health plan contractor compliance with managed care contract specifications, quality improvement goals and objectives and state and federal regulatory requirements. Plan, implement and execute request for proposals (RFP) for EQR and QIO contracts at least every three years. Collaborate with internal stakeholders (senior managers, peer staff and external managed care contractors) to develop RFP and subsequent contract language content. Plan and implement yearly and every three year budgets and statements of works for each EQR and in consultative capacity, QIO contract. Manage and monitor External Quality Review (EQR) and Quality Improvement Organization (QIO) (for QIO, in consultative
capacity) personal services contracts for the Washington State Managed Care programs to meet federally mandated health care quality measurement and improvement requirements. Provide necessary documentation of contractor qualifications and activities to meet contract monitoring expectations. Plan and oversee the EQR and QIO deliverables including the Consumer Assessment of Health Plans Survey (CAHPS), Health Employer Data and Information Set (HEDIS) performance measurement audit, and production of the CAHPS and HEDIS reports. Conduct annual audit of managed care organizations compliance with federal and state regulations and contract specifications, including health care quality management standards. Provide professional, clinical consultation as a member of the audit team;review health care clinical information (performance or clinically based improvement projects, medical necessity denial determinations, and appeals information). Perform analysis of data, providing senior-level professional consultation for agency direction on quality management standards and processes. Manage the Centers for Health Care Strategies grant on eliminating health care disparities.
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