Job Description

Job Title: Performance Improvement Crd - Harrisburg, PA
Job ID: 55543812
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Pinnacle Health Emergency Services
Department: Administration
Location: 111 South Front Street, Harrisburg PA 17105

Description

This position supports the performance improvement activities for the Medicaid, SNP, CHIP and adultBasic products. This includes the development and implementation of quality performance improvement plans, barrier analyses, medical management programs, interventions to improve performance, analyzing the results and preparing summaries of outcomes for the clinical programs. This position is also responsible for the research of clinical standards of care, reviewing data to identify opportunities, drafting of program descriptions, work flows, assessments, reports, training materials and other communication documents. This position will participate on multidisciplinary work teams related to performance improvement activities.

Responsibilities:
  • Collaborates with the clinical staff and other departments to collect information related to opportunities for improvement in clinical or service outcomes. This includes clinical programs or other NCQA clinical standards. Conducts barrier analysis and prepares summaries of findings and interventions.
  • Prepares performance improvement documents in format required by government agency, regulatory body or accrediting body. Completes research related to improvement activity, requests data, reviews reports and summarizes findings. Obtains information from clinical staff or other areas on interventions implemented related to opportunity.
  • Assists in developing tools and reports that will provide the clinical leadership management with information on progress of performance improvement initiatives, and outcomes for the programs. Analyzes results and prepares reports on findings for review by the clinical leadership.
  • Coordinates the scheduling of work team meetings, prepares documents, maintains minutes, and creates updates on the status of projects or programs. Assists the clinical team in drafting assessments, work flows, business rules, policies, procedures, and reports that support new or existing programs.
  • Reviews product HEDIS, CAHPS, HOS, and other satisfaction reports. Request additional reports as needed to identify opportunities for improvement. Assist in the development of effective interventions. Prepare reports or tracking tools to monitor improvements and summarize effectiveness of interventions. Assist in corporate wide work groups to impact these rates for all lines of business.
  • Assists in the development and implementation of training programs, tools, and other documents to help staff successfully implement and maintain clinical initiatives or programs.

Qualifications

  • Bachelor's degree in business, health care management, or related field required. 
  • Master's degree preferred (extensive related experience will be considered). 
  • Minimum of two years experience in performance improvement management required. 
  • Experience in health care insurance or health care industry preferred. 
  • Strong problem solving, organizational, and communication skills (oral and written) are required. 
  • This person must have the ability to coordinate the development and implementation of multiple large projects at one time, organizing tasks and deliverables needed to meet the objectives and timelines established for the programs.
  • Must be able to function in a complex environment.Must have strong analytical skills. 
  • Must be flexible. 
  • Must have strong computer skills including use of Word, Excel, Powerpoint, Access and Outlook.

Licensure, Certifications, and Clearances:
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $18.91 to $28.38 / hour

    Union Position: No

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