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   Current UPMC employees must apply in HR Direct

Program Manager- Health Plan Quality Analytics


The Program Manager will be responsible for developing, implementing, managing, and evaluating initiatives of HEDIS initiatives including but not limited to: manage HEDIS deliverables; track and monitor the Annual HEDIS Reporting operations to support CMS quality star ratings, NCQA's best plan ranking and the state requirement for Medicaid/CHIP; identify opportunities and potential barriers in HEDIS, CAHPS, and HOS; collaboratively work with Quality teams and operational areas for all population health programs as assigned; oversee and lead gap in care closure programs completion; lead and assist with department development and provide directions to staff in report development and production; data analysis and quality intervention; and special ad hoc projects.



  • Coordinate related activities for Annual HEDIS and HEDIS initiatives as necessary to ensure that all aspects of each program are successful and that all impacted departments are aware of progress/updates.
  • Manage the auditing process for Annual HEDIS, work with internal UPMCHP departments and auditors for a successful submissions
  • Lead the CAHPS/QHP Reporting process to Meet CMS and NCQA quality-oriented regulatory requirements based on HEDIS/CAHPS
  • Manage and perform business analysis for Quality Analytics department HEDIS data integrations and HEDIS Programs
  • Oversight of UPMCHP Gap in Care systems enhancing Quality Scores and collaboration with UPMCHP Partners
  • Work with various internal and external customers to provide relevant deliverables. This may include developing and negotiating contracts as needed with UPMCHP legal department.
  • Design and develop new project plans for new programs/events as needed, including all policies and procedures, program outlines, contracts as needed with participating facilities, and all marketing materials.
  • As relevant, manage, in part or in full, relevant staff to aid in project implementation
  • Meet project plan deadlines (these deadlines may require occasional extended daily work hours as necessary).
  • Manage various programs, campaigns, and events related to area of program expertise.
  • Summarize and interpret program results.
  • Identify division needs and report to management as appropriate
  • Implement programs for maximum results and member satisfaction.


  • Master’s degree in health administration or related health field preferred; or Bachelor’s degree with demonstrated successful experience in clinical program administration and/or other health related discipline.
  • A minimum of five to seven years of applicable experience in health care delivery is required.
  • Three years in health care insurance preferred.
  • Strong leadership and interpersonal skills.
  • Management experience preferred.
  • Strong computer skills, including proficiency in Microsoft Office, Word and Excel.
  • Excellent oral and written communication skills.
  • Excellent organizational and analytical skills.
  • Financial analytic skills preferred.
  • Candidate must demonstrate excellent written and oral communication skills.
  • Must be able to interact and negotiate with all facets of the wellness industry.
  • Excellent planning, documentation, organizational, analytical and problem solving skills are also required.
  • Candidate must demonstrate leadership and project management skills.
  • Ability to map re-engineering processes to positively impact productivity in terms of timeliness and accuracy.
  • Ability to work with and take direction from Senior Management.
  • Desire to continue upward progression within organization.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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