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Coordinator, Quality Improvement

  • Job ID: 825691810
  • 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: $28.33 to $47.73 / hour

Description

UPMC Health Plan has an exciting opportunity for a Quality Improvement Coordinator to support the Quality Improvement Department, located at the U.S. Steel Tower in downtown Pittsburgh. 

The Quality Improvement Coordinator coordinates QI activity and supports various functions within the scope of the Health Plan Quality Improvement Program, working both independently and as a team member. The functions may include but are not limited: to quality improvement initiatives; committee support; regulatory standard adherence; delegation oversight; performance monitoring and assessment; clinical practice guideline management; data collection, and analysis; and the continual advancement of the quality improvement process as a means to achieve the Health Plan's goals of excellence.


Responsibilities:

  • Support and champion UPMC Health Plan safety initiatives as assigned.
  • Perform duties and responsibilities in accordance with the philosophy, standards and policies and procedures of the UPMC Health System, including conveying courtesy, respect, enthusiasm, and a positive attitude through all contacts with staff, health plan members, providers, peers and visitors.
  • Work with UPMC Health Plan departments, such as Communication, and Network Relations, Member Services, Claims Payment, Pharmacy Services, Utilization and Medical Management, Prevention and Wellness Services, Credentialing and other departments and delegates to ensure that standards are met and appropriate documentation is maintained.
  • Work is conducted within the time parameters and in accordance with UPMC Health Plan Policies and Procedures, the Health Plan's Quality Improvement Description and Work Plan as well as the requirements and expectations of the Pennsylvania Department of Human Services, The Pennsylvania Department of Health, and any other state or federal agencies.
  • Assist with the coordinated responses to Requests for Information or Proposals for the UPMC Health Plan Business Development staff related to the Quality Improvement program.
  • Support the UPMC Health Plan Committee functions and activities as assigned. Ensure that meetings are organized, well documented, and that they meet the Health Plan goals and objectives and the individual Committee's roles and responsibilities.
  • Participate in the Quality Improvement, including data collection, performing root cause analysis, designing and/or implementing improvement plans, and monitoring and reporting results in accordance with the department's designated work plan.
  • Demonstrate appropriate application of policies, procedures, and guidelines through continuous learning. Ensure that performance measurement is sufficient to produce meaningful and accurate results. Council, guide, and instruct Health Plan employees on adherence to accreditation standards, HEDIS focused activities and other quality improvement initiatives.
  • Assume accountability for assigned standards for Centers for Medicare and Medicaid Services (CMS) and /or Pennsylvania Department of Human Services (DHS) annual review standards, including oversight of delegated activities. Work with UPMC Health Plan departments and delegates to ensure that the CMS and DHS standards and reporting requirements are met.
  • Support the UPMC Health Plan Committee functions and activities as assigned. Ensure that meetings are organized, well documented, and that they meet the Health Plan goals and objectives and the individual Committee's roles and responsibilities.

Qualifications

  • Bachelors' degree in a health care field or equivalent work experience required.
  • BSN or RN is preferred.
  • Health-related Masters is preferred. 5 years of health care experience is required.
  • Health insurance experience highly preferred.
  • Proficiency in Microsoft Word and Excel required; PowerPoint and Access proficiency preferred.
  • Excellent verbal, written and presentation skills are required.
  • Professionalism, enthusiasm and initiative are expected.
  • Ability to work independently and as productive team member is essential.
  • Knowledge of the National Committee on Quality Assurance (NCQA)
  • Standards for the accreditation of managed care organizations HEDIS specifications; the managed care environment and the basic tenets of continuous quality improvement are strongly preferred.
  • Experience with data collection, analysis and management is a plus.


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 — 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