Job Description

Job Title: Panel Management & Compliance Specialist- Temporary
Job ID: 725217
Status: Full-Time
Regular/Temporary: Temporary
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: WKP Comm WC Claims Admin
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a temporary Panel Management & Compliance Specialist to help support the Workers Compensation Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position. 

 

The Panel and Compliance Specialist is responsible for panel development, panel document creation and distribution, and panels vendor management for UPMC Work Partners' Workers' Compensation commercial and self-insured clients. The Panel and Compliance Specialist is also responsible for determining and operationalizing data analysis results by identifying provider concerns and bringing recommendations to provider management personnel. Along with this role the Panel and Compliance Specialist will further the development of data analysis tools used to measure compliance, and to ensure the accuracy of those tools. This position will also provide support to Work Partners' Network department through delivery of a wide array of administrative responsibilities that will augment the injured workers, client's and provider's experience regarding coordinated delivery of care following a workers' compensation injury.


Responsibilities:

  • Generate, distribute, maintain and evaluate health care provider panels and provider directories.  
  • Monitor and manage data input/maintenance of all provider information, manual and electronic transfer.  
  • Work in synergy with other members of the medical management team to bridge panel, network and provider gaps.  
  • Work collaboratively with operations teams to develop medical management data analysis tools.  
  • Perform high level analyses regarding panel functionality, compliance and other medical management components  
  • Present data analysis results to management teams as requested.  
  • Perform Quality Audit checks of the compliance report and panel tool.  
  • Prepare provider application/contract packets and fax/mail/email to provider.  
  • Review received applications/contracts for completeness.  
  • Enter application/contract information into appropriate tracking databases.

 

Qualifications

  • Bachelor's degree, preferably in Business or Science-related field preferred
  • Master's Degree in a related field preferred.
  • Experience in logistics or healthcare industries, and experience in workers¿ compensation preferred.
  • Strong presentation and communication skills (written and oral) and the ability to deliver presentations is required
  • Excellent computer skills, attention to extreme detail and analytical ability required
  • Excellent planning, documentation and organizational skills required. Candidates must also demonstrate leadership and project management skills.
  • Ability to identify panel opportunities and make suggestions to positively impact productivity in terms of timeliness and accuracy.
  • Ability to develop, maintain and communicate status updates and reports on success of panel development and compliance activities to medical delivery department management.
  • Demonstrated ability to work independently, take initiative and be self-motivated
  • Effectively prioritize and complete all assigned tasks.

    Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance or Act 34 Criminal Clearance with Renewal

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

 

Salary Range: $0 to $0

Union Position: No

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