RFP for External Quality Reviews for Medicaid Managed Care Organizations

The Oregon Health Authority is seeking a qualified External Quality Review Organization (EQRO) to perform annual External Quality Reviews (EQR) and compliance evaluations of Managed Care Organizations (MCOs) in the state's Medicaid program. The selected contractor will be responsible for conducting EQR activities, including validation of network adequacy, performance improvement projects, and information systems capability assessments. The contractor will also be required to develop EQR protocols and submit them for approval by the Agency. The contract term is expected to be 7 years, with the option for the Agency to amend the contract periodically. Key aspects of the job include: • Conducting EQR activities, including validation of network adequacy, performance improvement projects, and information systems capability assessments • Developing EQR protocols and submitting them for approval by the Agency • Conducting annual compliance reviews of MCOs • Providing technical assistance to MCOs and the Agency • Preparing EQR reports and submitting them to the Agency