At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds.

Our recruiters will continue to fill positions throughout this time, but 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.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Quality Management Clinician (Exton, PA)

  • Job ID: 697361439
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Quality-Satellite CH
  • Location: 1 East Uwchlan Avenue, Exton PA 19341
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

Do you have at least 3 years of clinical experience? Are you a strong communicator with excellent organizational skills? If so, UPMC may have the perfect fit for you!

UPMC is hiring a full-time Quality Management Clinician to support the Quality department within the Community Care Behavioral Health business unit. This will be Monday through Friday daylight role and will be based out of Exton, PA.

Due to COVID-19 circumstances, this position will be remote, but will eventually transition into a hybrid role (with travel to the office and/or provider sites). 

The Quality Management Clinician is responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC and the Commonwealth of Pennsylvania Department of Health quality assurance regulations.


Responsibilities:

  • Responsible for participating in projects as designated by other management staff, such as the Chief Medical Officer and VP of Medical Affairs.
  • Responsible for performing targeted, clinical audits and focus studies.
  • Responsible for logging in, tracking, monitoring, and reporting individual and aggregate complaints and grievances to the Senior Director of Quality Management and other leadership staff members as appropriate. Prepares formal reports and tracks timing of various levels of complaint and grievance for further action.
  • Responsible for assisting with preparation for NCQA, URAC, and other site visits.
  • Responsible for participating in updating the QM Plan.
  • Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff/committees, and aggregating the data on a monthly basis.
  • Responsible for identifying trends related to product and participating providers.
  • Responsible for preparing monthly and quarterly quality improvement reports to the Board.
  • Responsible for specified data collection related to all functional departments of Community Care.
  • Responsible for assisting with training responsibilities for providers, Members, and staff on various issues as assigned by the Senior Director of Quality Management.
  • Responsible for professional and staff development plan.

Qualifications

  • Licensed Registered Nurse (BSN preferred) or Masters Degree (licensure preferred).
  • 3 years clinical experience.
  • Experience in Quality Management procedures/processes preferred.
  • Knowledge of URAC, NCQA and HEDIS standards preferred.
  • Experience in managed care preferred.
  • Excellent organizational skills.
  • Experience in report writing, Microsoft Access, Microsoft Excel, collection and organization of large quantities of data.
  • Ability to maintain effective professional liaison with all levels of staff, including professional and institutional providers of care.
  • Independent problem solving related to job responsibilities based on knowledge of quality standards, clinically pertinent issues relatedto product and population served, and the operating practices of this organization.
  • Ability to identify trends or problem areas.
  • Demonstrates clinical knowledge of behavioral health related issues.
  • Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement.Excellent clinical, written and oral communication skills.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.


Licensure, Certifications, and Clearances:
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred.
 

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal


    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 — 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