PROJECT MANAGER, EQRO SERVICES



Date: 11.13

Grade: 12 – 14

Reports to: Executive Director/Associate Director

Service Line: State & Corporate Services

Status: Exempt

POSITION DESCRIPTION

Must have a current Arizona registered nurse license and a medical coding certification. If not a registered nurse, must have a medical coding certification (AHIMA, APC), background in clinical setting and medical coding experience with inpatient and outpatient services. This position, with direction, oversees designated State & Corporate Services Division's encounter data validation and focused study projects through various stages, including responding to RFPs; project initiation; recruitment selection, orientation, training, and supervision of subordinate staff; clinical data analysis, client relations; project planning and budgeting; completion of field work; and report preparation and finalization.

ESSENTIAL FUNCTIONS

Managing State and Private Focused Studies and Encounter Data Studies

 Provide technical assistance to internal and external clients regarding the CMS focused study and encounter data validation protocols

 Develop and adhere to project timelines, task schedules and all deliverables in a timely manner

 Oversee project design, data abstraction, medical coding validation of ICD-9, CPT and HCPCS level II codes and modifier coding assignments, data collection, monitoring, and report preparation

 Provide clinical and medical coding expertise while developing study methodologies with the Research and Analytics team

 Provide technical assistance pertaining to ICD-10 implementation to internal and external staff



　

 Work with Informatics Development Services to design data abstraction tools with business logic/edits, corresponding tool functionality instructions and abstraction instructions

 Develop training programs and provide technical assistance to state Medicaid, and private clients and contracted managed care entities related to project and review activities

 Coordinate and conduct state progress calls and on-site presentations

 Act as main day-to-day contact for state contacts and subcontractors



Other Administrative Duties

 Interview, hire, evaluate, counsel, and terminate project staff, and develop training based on needs assessment

 Coordinate project management tasks, including planning, budget analysis, staffing, communication (written and oral), coaching, and training.

 Draft responses and budget to RFPs

 Develop and adhere to project budgets

 Work with Executive Director or Associate Director to ensure contract tasks meet client and budget requirements

 Coordinate and communicate with other HSAG departments on project activities



ACCOUNTABILITY

Accountable to the Executive Director, or Associate Director, EQRO Services, for timeliness and accuracy of project activities within the State & Corporate Services Division.

WORK CONDITIONS

In this position, the employee may be subject to environmental conditions related to in and out-of-state travel.

PHYSICAL AND MENTAL DEMANDS/COMPETENCIES

 Ability to demonstrate initiative and problem solving abilities using root cause analysis principles.

 Ability to exercise decision-making skills utilizing professional judgment and discretion.

 Ability to communicate detailed ideas and instructions clearly and competently to staff and clients by written or spoken word.

 Ability to analyze and address client and company issues.

 Ability to coordinate numerous projects and tasks concurrently and efficiently.

 Ability to travel to presentations, meetings, and review sites statewide and out of state.

 Ability to learn and use computer software programs.

 Ability to adhere to established company confidentiality policies.



QUALIFICATIONS

 Bachelors’ degree in nursing or a registered nurse with a current Arizona license.

 Coding certifications (CPC, CCS and CCS-P) by AHIMA or APC.

 Minimum of five years’ working coding experience over various clinical settings.

 Minimum of five years clinical nursing experience across populations.

 Minimum of three years project management experience.

 Experience developing quality, clinical and non-clinical, measures.

 Exposure to standardized measure sets i.e., HEDIS, ARHQ, CMS, etc.

 Knowledge of clinical guidelines preferred.

 Knowledge of NCQA HEDIS measures preferred.

 Prior coding audit experience preferred.

 Supervisory experience of clinical staff preferred.

 Demonstrated knowledge or experience with HEDIS audit process.

 Experience with study methodology development and conducting focus studies preferred.

 Excellent oral and written communication and interpersonal skills with demonstrated ability to analyze and report clinical results.

 Familiarity with Windows environment.



DISCLAIMER

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts, or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change, e.g., emergencies, changes in personnel, workload, rush jobs, or technological developments.

Project Manager, EQRO Services Page