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Quality Management Specialist (Tobyhanna, PA)

  • Job ID: 26561680
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8:00 a.m. – 4:30 p.m. / 8:30 a.m. - 5:00 p.m.
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Admin-Sat CMP
  • Location: 300 Community Drive, Tobyhanna PA 18466
  • Union Position: No
  • Salary Range: $18.79 to $31.23 / hour

Description

UPMC is currently hiring a full-time Quality Management Specialist to support the Administration department within the Community Care Behavioral Health (CCBH) business unit. This will be a Monday through Friday daylight role (8:00 a.m. – 4:30 p.m. / 8:30 a.m. - 5:00 p.m.). This position will be based out of Tobyhanna, PA and will require occasional local travel to attend meetings.

 

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.

 

The incumbent will also provide administrative support (i.e. scanning and faxing documents, taking meeting minutes and providing phone/office coverage when applicable). Excellent computer skills and working knowledge of Excel and PowerPoint is highly preferred.



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 to assist 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 minute taking 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, collection and organization of large quantities of data 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:
N/A


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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