Associate Manager, Quality Management – Chester/Delaware Counties

UPMC Community Care Behavioral Health is hiring a full-time Associate Manager, Quality Management support the Quality Department in their Southeast Pennsylvania territory! This role will work daylight hours, Monday through Friday, in a hybrid work structure! While the home office is based in Media, PA this position will primarily be out in the field at provider sites or working remotely from home. Travel requirements ebb and flow due to business needs, but the territories will include Chester County, Delaware County, and surrounding counties.

Community Care Behavioral Health (CCBH) is committed to giving our neighbors the quality of life that they deserve. A proud part of the UPMC Insurance Services Division, CCBH provides members with the behavioral health treatment that they need for better health and a higher quality of life, including treatment for mental health conditions, drug or alcohol addiction, and developmental disabilities.

**As part of the application, a cover letter is highly recommended. 

The Associate Manager, Quality Management, operates under the guidance of the Senior Quality Manager and is responsible for assisting with functions related to quality management and improvement, in compliance with the Commonwealth of Pennsylvania Department of Health quality assurance regulations, Act 68, NCQA standards, URAC and HealthChoices reporting and quality improvement deliverables and Community Care needs. The Associate Manager, Quality Management facilitates local member complaints, denials and grievances, 2nd Level complaint and grievance meetings, and Significant Member Incident (SMI) investigations, and attends local quality-related Committee and ad hoc meetings. The Associate Manager, Quality Management also provides quality reports and other information exchanged with our local County contacts.

Responsibilities:

• Works with Provider Relations and management staff to ensure that credentialed and recredentialed practitioners and facilities meet Community Care quality standards.
• Responsible for facilitating interaction with various regulatory and oversight entities, including DPW, multiple county offices, etc. regarding the evaluation process.
• Independent problem solving based on sophisticated knowledge of quality standards (NCQA), URAC, clinically pertinent issues related to product and population served, and the operating practices of this organization.
• Responsible for the quality data collection, regarding services provided, population(s) served and network providers.
• Responsible for researching best practice provider evaluations models on a national basis.
• Identifies opportunities to present at local and major behavioral health and health care conferences.
• Responsible for the development, design, documentation and evaluation of the provider profiling process and the enhancement of provider reporting.
• Responsible for preparing monthly and quarterly quality improvement reports.
• Knowledge and Ability to supervise and direct the work of others.
• The position reports to the Senior Manager, Quality Management in the corresponding region and with a matrix report to the Director and Senior Director of Quality Management.
• Responsible for identifying trends related to network providers.
• Ability to analyze data related to product and participating providers.
• Ability to propose and implement creative solutions to identified trends or problem areas with recommendations for improvement.
• Responsible for participating and/or oversight of complaints, denials and grievances
• Responsible for designing and conducting targeted audits, when needed
• Proficiency in windows based applications preferred
• Responsible for new and ongoing projects, as assigned, including management of the comprehensive provider evaluation process.
• Responsible for analysis of data collected
• Responsible for designing and performing on-site audits of medical records, when needed. Assists with training responsibilities for providers, members and staff on identified issues.
• Demonstrated knowledge of clinical treatment.
• Responsible for management of the provider benchmarking process
• Excellent clinical, written and oral communication skills.
• Ability to identify trends or problem areas.
• Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
• Collaborates with Community Care committees to develop, implement and report quality improvement initiatives to improve services are across the organization.