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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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Quality Management Specialist

  • Job ID: 174362410
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Quality
  • Location: 339 Sixth Avenue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $20.60 to $34.22 / hour

Description

UPMC Community Care Behavioral Health is seeking a full-time Quality Management Specialist to support the CCBH Quality Department!

The Quality Management Specialist will work standard hours, Monday through Friday, with the opportunity to primarily work from home! This role will have occasional in-office days at the Heinz 57 Center in Downtown Pittsburgh for team meetings, quarterly meetings, and other events. 

The Quality Management Specialist is responsible for performing functions related to quality management and improvement in compliance with NCQA, HEDIS, URAC, the Commonwealth of Pennsylvania Department of Health quality assurance regulations, and all other regulatory and oversight agencies. Responsibilities include, but are not limited to, navigating the department's mental health system, supporting projects, assisting with department meetings, sending correspondence on behalf of the department, and supporting Excel and Teams projects. 

The ideal candidate for this position will be an independent worker with strong communication and computer skills! Proficiency in Excel is preferred, as is some clinical and/or medical terminology knowledge. 

 

Responsibilities:

  • Prepares formal reports and tracks timing of various levels of report completion.
  • Responsible for specified data collection related to all functional departments of Community Care.
  • Responsible for tracking committee actions and outcomes for feedback to the appropriate individual/committee.
  • Responsible for preparing reports to be sent to cross-contract oversight agencies.
  • Responsible for performing targeted audits.
  • Responsible for assisting with preparation for NCQA, URAC, and other site visits.
  • Responsible for appropriate correspondence related to managing quality data.
  • Responsible for logging, tracking, monitoring, and reporting individual and aggregate reports to the Management staff of the Quality Management department and other leadership staff, as appropriate.
  • Responsible for written quality newsletters and assisting with the provider and member newsletters as indicated.
  • Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff, and aggregating the data on a monthly basis.
  • Prepares weekly, monthly, quarterly, and annual reports and tracks timeliness of investigation and follow-up of identified significant member events.
  • Responsible for assisting with tasks related to the Outcomes Department and other departments as assigned by quality management staff.
  • Responsible for participating in updating the QM Plan.
  • Responsible for identifying trends related to product and participating providers.
  • Responsible for taking minutes at the Board Quality Improvement Committee and other quality committees, as assigned.
  • Responsible for preparing monthly and quarterly quality improvement reports to the Board.

 

Qualifications

  • Bachelor's Degree preferred.
  • Experience in managed care preferred.
  • Excellent organizational skills.
  • Experience in report writing, Microsoft software, and collection and organization of large quantities of data preferred.
  • Proficient Excel skills preferred.
  • Ability to maintain effective professional liaison with all levels of staff, including professional and institutional providers of care.
  • Independent problem-solving related to job responsibilities based on knowledge of quality standards, pertinent issues related to product and population served, and the operating practices of this organization.
  • Ability to identify trends or problem areas.
  • Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement.
  • Excellent clinical, written, and oral communication skills.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.


Licensure, Certifications, and Clearances:

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

 

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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