Janice Acar, R.N., B.S.
Senior Director, Managed Care
Ms. Acar leads IPRO's External Quality Review (EQR) contracts for the Commonwealth of Kentucky and the State of Rhode Island, and provides support for the New York State EQR contract. External quality review activities include: conducting focused quality of care studies, monitoring Managed Care Organization (MCO) compliance with state and federal managed care regulations and requirements, encounter data validation, member and provider surveys, validation of MCO-reported performance measures and MCO-conducted performance improvement projects, and overall assessment of the quality, timeliness, and access to health care services provided by Medicaid MCOs.
Ms. Acar is project lead for the CMS Deeming Validation Review project, in which IPRO conducts validation reviews of national accreditation organizations that have been granted deeming authority for MAOs.
She is also project lead for the Medicare Special Study, Medicare Advantage Quality Review Organization (MAQRO). The MAQRO has been responsible for the development of reporting, review and scoring protocols and tools, the related instructional guides and training materials, and for review of MAO (Medicare Advantage Organization) quality improvement projects. The MAQRO will also review MAO Chronic Care Improvement Programs, a new CMS MAO requirement.
Ms. Acar has supervised the development, implementation and ongoing operation of various Medicaid and Medicare quality improvement projects, has assisted in the design and conduct of data validation studies, and has participated as a secondary auditor for HEDIS® and QARR audits.
Ms. Acar has conducted on-site visits to Managed Care Organizations (MCOs) to monitor compliance with state and federal requirements and provide technical assistance to MCO staff.
She has a Bachelor of Science degree in Nursing from the State University of New York at Stony Brook.