Quality Assurance Contracts Manager
Location
North Carolina
Posted
1 day ago
Salary
$65K - $71.4K / year
Seniority
Lead
Job Description
Quality Assurance Contracts Manager
State of North Carolina
Title: Quality Assurance Contracts Manager Location: Wake County, North Carolina Work Arrangement: Hybrid Employment Type: Full-time Salary: $65,000 - $71,443 (recruitment range) Position Type: Time-Limited (24 months) 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 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 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. 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. 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. 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. 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 also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit website for State Benefits Supplemental and Contact Information The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federal laws, 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: https://www.ncdhhs.gov/ . 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 Governor's 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. 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. 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 accepted. Applications must be submitted by 11:59 PM the night BEFORE the closing date. If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 11:59 PM the night BEFORE the closing date. • Applicants may be subject to a criminal background check. All candidates selected for positions considered "Positions of Trust" will be subject to a criminal background check. Applicants may be subject to a criminal background check. All candidates selected for positions considered "Positions of Trust" will be subject 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. 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 application. The 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. Degrees must be received from appropriately accredited institutions. Transcripts and degree evaluations may be uploaded with your application. The 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 https://www.naces.org/members . For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.naces.org/members . Degree/College 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 a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications. Applicants seeking Veterans Preference must attach a DD-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 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. 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 talentacquisition@dhhs.nc.gov . 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. • Bachelor's degree in business or related area from an appropriately accredited institution and four years of progressive procurement or contract administration experience; or Bachelor's 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. 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. Necessary Special Requirements Completion of the North Carolina Contract Management Certification Program within one year of hire into the position. EEO Statement T he 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: Email: talentacquisition@dhhs.nc.gov
Related Guides
Related Categories
Related Job Pages
More Manager Jobs
LVN Case Manager - Disease Management
UnitedHealth GroupUnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description The Associate Care Manager facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers and other resources to evaluate, plan, facilitate and monitor options and services required to meet an individual’s healthcare needs. Promotes member’s goals for self-management, facilitates effective health care navigation, reduces gaps in care, and provides support and community resources as needed. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Must have a valid CA nursing license. Primary Responsibilities: - Conducts clinical evaluation of members per regulated timelines, determining who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and gaps in care. - Conducts individual interview to obtain data for focused assessment and determines individual needs and prioritizes goals. - Conducts telephonic, clinic, facility, hospital or home visits as indicated for patient evaluation/engagement. - Identifies barriers to care and seeks solutions with member and the care team. - Participates in the development and implementation of a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals. - Performs activities identified on the individual needs and prioritized goals to evaluate effectiveness, and to document interventions and goal achievement. - Maintains member case load for regular outreach and management and closes cases per procedure. - Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts. - Maintains a working knowledge of community resources. - Achieves productivity and audit standards per department requirements. - Serves as facilitator and resource for other members of the medical group or clinical teams. - Attends departmental meetings and provides constructive recommendations for process improvement. - Ability to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice. - Performs other duties as assigned. Qualifications - Graduation from an accredited Licensed Vocational Nurse program. - Active compact license in CA. - 2+ years of recent clinical experience working as an LVN/LPN. - 1+ years of care management, disease management or discharge planning experience. - Access to dedicated workspace from home or an in-home office set up. - Reside in a location that can receive a high-speed internet connection. Requirements - All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients. - Must hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growth. - Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction. - Follows written and oral instructions and completes routine tasks independently. - Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed Agreements. - Ensures confidentiality of patient information following HIPAA guidelines and company policies. - Attends training to meet requirements of the job position and as needed or mandated by company policies and regulations. - Has regular and predictable attendance. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). - The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
• Develops productive partnerships that serve to drive business forward, including but not limited to: Saks Global stores, Buyers, and Planners with a focus on: High volume and/or high potential strategic merchandise opportunities • Captures high-level merchandise feedback from store visits, corroborates recommendations with data, and develops action plans (i.e. category expansion, floor productivity, brand matrix edits) • Identifies merchandise category opportunities in key markets utilizing: ○ Evolving customer, market, and competitive trends ○ Division, group and/or specific vendor knowledge • Provides Saks Global stores and executives with custom reporting and presentations including, but not limited to: Seasonal launches, category initiatives, store relayer proposals • Assists in preparing weekly business review for stores in collaboration with the SVP, Accelerated Store Growth • Holds stakeholders accountable to execute action plans and deliver results. Reports out results to pertinent leadership in a timely manner • Ad hoc responsibilities as needed
• Own Program Strategy & Design: Identify pipeline gaps across segments and design outbound programs (pipegen, pipe progression) to address them. • Drive Cross-Functional Alignment: Serve as “the glue” for GTM teams across Sales, Enablement, Marketing, and Operations. • Execute with Operational Rigor: Manage the full program lifecycle end-to-end. • Analyze & Iterate: Diagnose business hotspots and pipeline health signals. • Build for Scale with AI: Find new ways of working using AI. • Champion Samsara’s Culture: Champion, role model, and embed Samsara’s cultural principles.
Case Manager - Registered Nurse
UnitedHealth GroupUnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Role Description The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning. It is the purpose of the Care Manager – Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members’ home. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Develop a comprehensive care management plan that will address members’ individual needs which include specific objectives, goals, and actions. - Prioritizes member care needs upon initial interaction/assessment and address emerging issues. - Assist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary team. - Assesses reports, data, and other health plan information to identify potential members in need of care management intervention. - Decrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home health. - Monitor the effectiveness of the care management plan and short/long term goals and adjust per member need. - Assesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time frames. - Provides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up care. - Develops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for members. - Independently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelines. - Provides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines. - Acts as liaison and members advocate with other care providers and programs. - Participate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference). - Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes. - Develop an effective support system within the family and community to manage emergency situations and to provide support and safety for the members. - Acts to prevent suicide and homicide in accordance with state licensure requirements. - Supports collection of information and other statistical data relevant to care loads, productivity and health care trends within member population. - Potential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policies. - Maintain overall accountability for member care outcomes delivered by LPN/LVN. - Review and validate care plans developed or supported by LPN/LVN staff. - Provide real-time guidance, coaching and clinical support to LPN/LVN staff. - Performs additional duties as assigned. Qualifications - Degree in Nursing from an accredited school of nursing. - Unrestricted RN licensure. - CA license. - CCM Certification within three years of employment. Requirements - Working knowledge of health care delivery systems. - Working knowledge of PC applications including MS Office Suite and other supportive technology. - Ability to use written and oral communication skills. - Ability to read and interpret data. - Skill in writing clear, grammatically correct, easy to use instructional documentation. - Ability to identify learning needs, set goals and seek educational opportunities. - Ability to analyze problems and formulate appropriate plans, solutions, and courses of action. - Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally. - Ability to work with frequent interruptions. - Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates. - Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners. - Ability to manage detail and work with accuracy. - Ability to recognize and act appropriately in situations where patient care needs exceed scope of practice. - Skill in working with a team and the ability to collaborate on projects with colleagues. - Skill in working effectively under deadlines and changing priorities. - Ability to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
