Job Description

Job Title: Quality Management Clinician
Job ID: 93412873
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Community Care Behavioral Hlth
Department: Quality
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

Do you have a Masters' degree or are you a Licensed Registered Nurse? Do you have at least three years of clinical experience? If so, UPMC may have the perfect fit for you!

 

UPMC is hiring a full-time Quality Management Clinician. This is a Monday through Friday daylight role (8:00 a.m. - 4:30 p.m. or 8:30 a.m. – 5:00 p.m.) and will be based out of downtown Pittsburgh, PA. Occasional travel is required within the state, to conduct record reviews at provider site locations and/or to attend trainings.

 

The Quality Management Clinician is responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC and the Commonwealth of Pennsylvania Department of Health quality assurance regulations.



Responsibilities:
  • Responsible for participating in projects as designated by other management staff, such as the Chief Medical Officer and VP of Medical Affairs.
  • Responsible for performing targeted, clinical audits and focus studies.
  • Responsible for logging in, tracking, monitoring, and reporting individual and aggregate complaints and grievances to the Senior Director of Quality Management and other leadership staff members as appropriate. Prepares formal reports and tracks timing of various levels of complaint and grievance for further action.
  • Responsible for assisting with preparation for NCQA, URAC, and other site visits.
  • Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff/committees, and aggregating the data on a monthly basis.
  • Responsible for identifying trends related to product and participating providers.
  • Responsible for preparing monthly and quarterly quality improvement reports to the Board.
  • Responsible for specified data collection related to all functional departments of Community Care.
  • Responsible for assisting with training responsibilities for providers, Members, and staff on various issues as assigned by the Senior Director of Quality Management.

Qualifications

  • Licensed Registered Nurse (BSN preferred) or Masters Degree (licensure preferred). 
  • 3 years clinical experience.
  • Experience in Quality Management procedures/processes preferred.
  • Knowledge of URAC, NCQA and HEDIS standards preferred.
  • Experience in managed care preferred.
  • Excellent organizational skills.
  • Experience in report writing, Microsoft Access, Microsoft Excel, collection and organization of large quantities of data.
  • 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, clinically pertinent issues related to product and population served, and the operating practices of this organization.
  • Ability to identify trends or problem areas.
  • Demonstrates clinical knowledge of behavioral health related issues.
  • 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:
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred.

  • Act 31 Child Abuse Reporting
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance


  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $23.28 to $40.28 / hour

    Union Position: No

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    UPMC VALUES

    At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

    QUALITY & SAFETY
    DIGNITY & RESPECT
    CARING & LISTENING
    RESPONSIBILITY & INTEGRITY
    EXCELLENCE & INNOVATION

    UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


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