Job Details

Quality Assurance & Compliance Specialist (OPA3)

Oregon Health Authority, Salem, Oregon

Full Time - Health

Salary Range: $5,106 - $7,847

Close Date: 11/07/2020

Quality Assurance experience? Experience in development of program rules and requirements? Operations and policy analytical experience and great communication skills? If you answered yes, Human Services Division of the Oregon Health Authority wants you to apply today!

What you will do!
You will provide operational, regulatory, and medical/clinical expertise in the development of compliance tools!  
You will establish short-term operational goals and long-range objectives for quality assurance performance in managed care programs!
You will conduct quality management activities for medical, dental, and behavioral health services provided to Oregon Health Plan members!
You will develop comprehensive reports for federal regulators, state and federal advisory committees and evaluators and the public, including client constituencies and other agencies or states!

What's in it for you?

  • A Bachelor's Degree in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills; and four years professional-level evaluative, analytical and planning work;
OR; Any combination of experience and education equivalent to seven years of experience that typically supports the knowledge and skills for the classification. Some of this experience needs to be specific to Human Services, Medicaid and/or Mental Health.
  • Experience in advancing health equity, addressing systemic health disparities and collaborating with diverse, vulnerable and underrepresented populations.
  • Oregon Nursing or Behavioral Health license or Compliance certification preferred or other medical/clinical or compliance professional credentials.
  • Knowledge and experience with Centers for Medicare and Medicaid Services (CMS) waiver and demonstration projects.
  • Experience interpreting, applying and enforcing relevant federal and state Medicaid laws and regulations, including Medicaid Managed Care regulations.
  • Knowledge and experience with evaluating the cost effectiveness, access, and quality of health care programs and utilization of health care metrics.
  • Experience using expenditure and utilization data and trends to manage, plan, and evaluate cost effectiveness, access, and quality of medical program and drive change to create improvement strategies.
  • Problem solving skills including the ability to analyze data and recommend changes based on\analysis.
  • Preference for demonstrated experience leading or managing compliance functions along with performance or process improvement efforts in health insurance, health care systems, or other delivery systems.
How to apply:
  • Complete the online application at using job number REQ-50551