Job Description

Job Title: Critical Incident Investigator I
Job ID: 14753599
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Improvement
Location: 600 Grant St, Pittsburgh PA 15219


UPMC Health Plan is hiring a full-time Critical Incident Investigator to help support the UPMC Community HealthChoices Quality Improvement Department for its downtown Pittsburgh location at the US Steel Tower.

Community Health Choices will impact more than 400,000 people statewide who are dually eligible for Medicare and Medicaid or receive Medicaid funded long-term services and supports (LTSS). Through Community HealthChoices (CHC), we coordinate physical health care and LTSS to enhance the quality of life and independence for frail seniors and adults with disabilities in home and community-based environments as well as in institutional settings.

This is a Monday through Friday daylight position. The successful candidate will report, track, and manage critical incidents for Community HealthChoices (CHC) participants. This position will ensure critical incidents are responded to thoroughly, effectively, and timely and work closely with Complaints & Grievances, service coordinators, quality improvement coordinators, and other staff in the health plan to investigate incidents, trends, Quality of Care concerns, and ensure all parties required are contacted within specified timelines. Incident Reporting data will be collected and analyzed for quality measures, timeliness of response, and effective resolution.


  • Document findings in electronic systems and actively record all activities on open cases in a timely manner.
  • Monitor various intake queues for critical incidents to report to the Pennsylvania Office of Long-Term Living.
  • Interview providers and service coordinators or other parties to collect and evaluate relevant information and make decisions related to the investigation, provider actions, and contacts needed to other units or agencies to assure the participant?s safety.
  • Review medical records, service plans, assessments and other collateral information to recommend follow up actions needed to mitigate risk and prevent further incidents from occurring
  • Provide incident summary responses both orally and in writing to various managers by request.
  • Report and investigate critical incidents reported to the health plan regarding participants in long term services and supports, including allegations of abuse, neglect or exploitation of person or property.
  • Identify and address provider non-compliance in accordance with health plan's policy.


  • Bachelor's degree in Human Services, Criminal Justice, or Social Work or Associate's degree and 2 years of related work experience (investigations, criminal justice, service coordination, or long-term services and supports at an administrative level).
  • Knowledge of commercial, Medicaid, Medicare products, managed care principles, and home and community-based services preferred.
  • Competent in MS Word, Outlook, Excel, web-based healthcare applications.
  • Strong organizational, interpersonal, and verbal and written communication skills.
  • Ability to successfully meet deadlines and manage multiple priorities in a fast-paced environment.
  • Strong critical thinking, judgment, and problem-solving skills.

    Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $18.79 to $31.23 / hour

Union Position: No

Apply Current Employee?


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!


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.


Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

UPMC Health Plan Named Best Places to Work for LGBTQ Equality in 2019

UPMC Ranked #1 Best Places for Women and Diverse Managers in 2019

Talent Network