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

NCQA Quality Improvement Coordinator

  • Job ID: 998484529
  • 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 is hiring a full-time Coordinator, Quality Improvement to help support the Quality Improvement Department’s NCQA team located in the downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.  The team is currently working remotely but will return to the downtown office in the future.
 
The focus of this role is NCQA accreditation.  The ideal candidate will have prior experience with NCQA, but a background in other regulatory or accreditation compliance experience will also be considered.  Experience writing quantitative and qualitative analysis is preferred.

The NCQA 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 committee support; regulatory and accreditation standard adherence; delegation oversight; performance monitoring and assessment; data collection and analysis; and the continual advancement of the quality improvement process 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.
  • Assume accountability for assigned standards from the National Committee for Quality Assurance (NCQA), which may involve oversight of delegated activities. Work with UPMC Health Plan departments, such as Communication, Contracting, 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 NCQA 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 Program 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 and accreditation 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.
  • 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.
  • Adhere to the UPMC Health Plan HIPAA Compliance Guidelines. Ensure that HIPAA standards are met in all aspects of the Department functions including delegated functions. Ensure that all releases of member personal health information, which are conducted outside of the realm of Treatment, Payment, or Operations are appropriately documented.

Qualifications

  • Bachelors' degree in a health care field or equivalent work experience required.
  • Health-related master’s is preferred.
  • 5 years of health care experience is required.
  • 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 a productive team member is essential.
  • Knowledge of the National Committee on Quality Assurance (NCQA), standards for the accreditation of Managed Care Organizations, 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.
  • Experience writing quantitative and qualitative analysis is a plus.
  • Other regulatory or accreditation compliance experience strongly considered.


Licensure, Certifications, and Clearances:

  • Driver's License

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