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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Associate Manager, Quality Management - State College, PA

  • Job ID: 417219267
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Quality-Sat NC-CEN
  • Location: 2505 Greentech Drive, State College PA 16803
  • Union Position: No
  • Salary Range: $31.08 to $52.46 / hour

Description

UPMC and Community Care Behavioral Health (CCBH) has an exciting opportunity for an Associate Manager, Quality Management! This is a regular, full-time position with hybrid work arrangements and working up to approximately 10% travel. 

The Associate Manager, Quality Management, operates under the guidance of the 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 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.

 

Qualifications

  • 5 years clinical experience.
  • 2 years in a progressive management/leadership experience in behavioral health
  • Master's degree required.
  • Licensed healthcare professional preferred.
  • Experience with substance use disorders and mental health preferred.
  • Strong background experience in managed care preferred.
  • History of quality management implementation and participation.
  • Ability to implement quality assurance policies and to enforce those policies through appropriate action.
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.

Licensure, Certifications, and Clearances:
Pennsylvania Licensure: LSW, LCSW, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred. Certification in Behavioral Health specialties preferred.

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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