At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

UPMC Life Changing Medicine
Search Our Jobs

   Current UPMC employees must apply in HR Direct

Program Manager- Health Plan Quality Analytics

Description


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.

 

Responsibilities:

  • 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.

Qualifications

  • 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

Talent Network