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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

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Quality Management Clinician (State College, Moosic or DuBois, PA)

  • Job ID: 429438031
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Quality-Sat NC-SCR
  • Location: 2505 Greentech Drive, State College PA 16803
  • Union Position: No
  • Salary Range: $24.78 to $42.84 / hour

Description

At UPMC, we’re all here for the same reason – to make Life Changing Medicine happen. Join our team and you will play a unique and important role in our mission to change healthcare for the better.

UPMC is hiring a full-time Quality Management Clinician to support the Quality department within the Community Care Behavioral Health (CCBH) business unit. This is a Monday - Friday daylight role (8:00 a.m. - 4:30 p.m. or 8:30 a.m. - 5:00 p.m.). This is a hybrid role with remote/work-from-home privileges in PA and some travel into the office for trainings, meetings, department needs, etc. The office base can located at any of our CCBH North Central office locations (State College, Moosic or DuBois).

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 related to 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.
 

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  • Act 73 FBI Clearance with renewal

    UPMC is an Equal Opportunity Employer/Disability/Veteran

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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