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Senior Manager, Quality Improvement

  • Job ID: 443603304
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Quality Improvement
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $36.11 to $61.13 / hour

Description

UPMC Health Plan is hiring a full-time Senior Manager to support the Quality Improvement Department in its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.  The ideal candidate will have prior experience in healthcare quality improvement.
 

The Senior Manager will strategically implement and manage all aspects of UPMC Health Plan's quality improvement plan, NCQA accreditation, CMS, DPW and PID quality requirements. Leadership role in the development, implementation, reporting, communication and facilitation of quality improvement initiatives between all UPMC Health Plan departments, physician network and regulatory entities related to HEDIS and regulatory and accreditation functions. This role supports a variety of Health Plan decision-making activities in the network, medical management, pharmacy, marketing, and member service departments.

Responsibilities:

  • Oversee all delegation activities related to NCQA standards, coordinating with appropriate Health Plan departments for reporting, annual reviews and development, and monitoring of corrective action plans.
  • Responsible for NCQA accreditation preparation and review.
  • Responsible for CMS, DPW, PID quality improvement functions and reporting.
  • Responsible for meeting all NCQA managed care standard requirements.
  • Responsible for CMS deeming review process through NCQA.

Qualifications

  • A bachelor's degree in health care management or related field required; master's degree preferred (extensive related experience will be considered).
  • Minimum of five years of experience in quality improvement, including analysis, report generation, trend reporting, and improvement work plans.
  • Managed care quality improvement experience required.
  • Experience with NCQA, HEDIS, CMS, and other regulatory quality requirements required.
  • Excellent presentation skills, experience in leading management level meetings.
  • Strong project management skills required, ability to perform planning for large initiatives/projects, as well as manage all tasks required to meet departmental and business needs.
  • Experience with state/federal quality reporting processes and requirements, such as present on admission, CMS indicators, and DPW measurements.
  • Proficiency in Microsoft Office, including Word, PowerPoint and Excel.


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