Quality Assurance Focused Review Coordinator- hybrid

UPMC Health Plan is hiring a full-time Quality Assurance Focused Review Coordinator to help support the HPLAN-Quality Assurance and Operational Integrity Department.

This position is remote but travel to the office will be needed at times for business needs on rare occasions. 

 In this role, you must use UPMC Health Plan internal processes and information systems to recommend and implement project plans. You will coordinate external audits, including but not limited to, defining the scope and verifying requirements/deliverables, coordinating all aspects of onsite visits, coordinating document requests and audit responses. This position is also responsible for reporting results to management as needed.

The coordinator will be responsible for overseeing multiple projects at any given time. You will develop and utilizes key metrics to measure and report on progress of initiatives while also assisting team members in resolving project problems. You will monitor health plan operating performance against regional and national benchmarks and perform cost/benefit analysis to assist with strategic goals.

Responsibilities:

• Projects – Define and develop overall objectives, scope and work plan and review and confirm with internal and external clients utilizing standard project management.
• External Audits – Coordinate external audits of the company: Define the scope and verify requirements/deliverables Determine/identify/notify departments for participation in the audit.
• Create audit checklist based upon the type of audit and the requirements (i.e. Claim audit, Medical Loss Ratio, Financial, etc.)
• Coordinate all aspects of onsite visit if applicable (building security, conference rooms, scheduling meeting dates/times, department tour, etc.)
• Coordinate universe, documentation requests, etc. and create folders and track audit progress
• Make appropriate entries into external audit database to aid in tracking and reporting Coordinate audit responses
• Follow up on audit compliance items
• Maintains Project Reporting Database – manage project inventory.
• Build follow-up mechanism/maintenance plan into projects and/or reviews to ensure that changes to be implemented will be completed timely. Ensure business value has been delivered.
• Demonstrate ability to prepare sensitive information and communicate it directly to senior management.
• Support the QA department’s functions and activities assigned.
• Ensure that meetings are organized, well-documented and they meet the health Plan goals and objectives.
• Prioritize tasks based on relative importance and urgency and identify dependencies across projects.
• Recognize and act decisively in urgent matters; make tough decisions which may influence the direction of the project.
• Direct and execute creative analytic approaches/ create new or adapt existing analytical methods and tools to solve problems.
• Cooperate closely with business leaders and/or management. Identify and mitigate business risks associated with projects.
• Dynamically lead presentations / work sessions to positively influence decisions and perceptions.
• Plan, organize and control multiple responsibilities and solicit participation from cross-functional resources and ensure that the most appropriate resources are assigned to specific project roles.
• Establish a mentoring environment.
• Plan and execute communication of complex information to team members and stakeholder groups.