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Manager, Quality Management (Camp Hill, PA)

  • Job ID: 701166261
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Quality-Satellite
  • Location: 1200 Camp Hill Bypass, Camp Hill PA 17011
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

Do you have a Master’s degree and at least 5 years of varied clinical experience? Do you have 2 years of progressive management/leadership experience in behavioral health? If so, UPMC may have the perfect fit for you! 

UPMC is hiring a full-time Manager of Quality Management to support the Quality department with the Community Care Behavioral Health (CCBH) business unit. We are looking for an experienced candidate who has a minimum of five years’ of clinical experience. This would be a Monday through Friday daylight position (8:30 a.m. - 5:00 p.m.). The position will based out of Camp Hill, PA and will cover two contracts (York/Adams and Berks counties).

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

The Manager, Quality Management is responsible for managing and performing functions related to quality management and improvement, in compliance with the Commonwealth of Pennsylvania Department of Health quality assurance regulations, Act 68, URAC, NCQA standards and HealthChoices reporting and quality improvement deliverables and Community Care needs. The Manager, Quality Management facilitates and manages new and ongoing projects, including management of the comprehensive provider evaluation process for all contracts across the company and attends local quality-related Committee and ad hoc meetings.


Responsibilities:

•    Responsible for participating and/or oversight of complaints, denials and grievances.
•    Responsible for new and ongoing projects as assigned, including management of the comprehensive provider evaluation process.
•    Responsible for management of the provider benchmarking process.
•    Responsible for researching best practice provider evaluation models on a national basis.
•    Responsible for facilitating interaction with various regulatory and oversight entities, including DHS, multiple county offices, etc. regarding the evaluation process.
•    Responsible for the development, design, documentation and evaluation of the provider profiling process, and the enhancement of provider reporting.
•    Responsible for quality data collection, regarding services provided, population(s) served, and network providers.
•    Responsible for analysis of data collected.
•    Responsible for identifying trends related to network providers.
•    Responsible for preparing monthly and quarterly quality improvement reports.
•    Responsible for designing and conducting targeted audits, when needed.
•    Responsible for designing and performing on-site audits of medical records, when needed.
•    Assists with training responsibilities for providers, Members, and staff on identified issues.
•    Identifies opportunities to present at local and major behavioral health and health care conferences.
•    Works with Provider Relations and management staff to ensure that credentialed and recredentialed practitioners and facilities meet Community Care quality standards.

Qualifications

  • 5 years clinical experience.
  • 2 years in a progressive management/leadership experience in behavioral health.
  • Master's degree required.
  • Licensed healthcare professional preferred.
  • Strong background in managed care preferred.
  • History of quality management implementation and participation.
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.
  • Excellent clinical, written and oral communication skills.
  • Independent problem solving based on sophisticated knowledge of quality standards (NCQA & URAC), clinically pertinent issues related to product and population served, and the operating practices of this organization.
  • Ability to manage multiple projects from initiation to implementation by targeted completion dates.
  • Ability to identify trends or problem areas.Ability to propose and implement creative solutions to identified trends or problem areas with recommendations for improvement.
  • Ability to analyze data related to product and participating providers.
  • Knowledge and Ability to supervise and direct the work of others.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
  • Demonstrated knowledge of clinical treatment.


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

  • Act 31 Child Abuse Reporting with renewal
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal



    UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct