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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Clinical Improvement Specialist

  • Job ID: 157640915
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Network Management
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $33.86 to $57.80 / hour

Description

UPMC Health Plan is hiring a full-time Clinical Improvement Specialist to support the Network Management department. This role will work standard daylight hours, Monday through Friday. This position will involve travel throughout Western PA to physician practices and will work remotely when not traveling. 

This position is directly responsible for implementing the value creation strategy for each of the primary care provider groups (Partners) enrolled in the UPMC Health Plan's Value-based Reimbursement program. In this role, the Clinical Improvement Specialist works directly with primary care providers and their office staff to support them in clinical improvement activities that will allow for Partners to achieve clinical, quality, and financial performance goals and/or ROI targets identified for the Partner's member population. This job is a highly skilled subject matter expert in quality (Medicare STARS, Medicaid HEDIS, etc.) and works closely with the internal UPMC Health Plan staff and PCP practices for the regular review and analysis of their performance in quality. This job also has subject matter expertise in continuous quality improvement and can work with primary care providers and their office staff to identify and design new processes and practice workflows that will enable the transformation of care delivery to better support Partners in achieving their goals. The individual in this role must be able to work collaboratively in a matrixed environment, have strong interpersonal skills, be organized and self-directed, and enthusiastically represent the Organization and its mission and goals.


Responsibilities:

 

  • Serves as the on-the-ground clinical subject matter for quality (Medicare STARS, HEDIS) and supports practices with this knowledge and expertise. Works collaboratively with the internal UPMC Health Plan quality team to translate quality insights into best for the PCPs.
  • Serves as the on-site quality improvement and best practices champion for primary care practices bringing together various UPMC Health Plan field-based efforts into a coordinated on-the-ground approach that supports Partners in achieving goals in value-based reimbursement.
  • Provides assistance and support to assigned physician practices enabling them to resolve daily operational issues including claims and network-related inquiries
  • Works with the Partner to assess current state and facilitates workflow redesign to help the Partner implement best practices, better incorporate data-driven insights, and/or use the right tools to help the Partner achieve performance goals. Uses continuous quality improvement methodologies to facilitate improvement and change.
  • Collaboratively works with the Partner to implement the performance improvement strategies in conjunction with the UPMC Health Plan internal team. Manages all the information necessary to track progress on the Partner-specific value-based reimbursement strategic plan.
  • Provides assistance to the PCPs and their office staff in the use of user interfaces, population health management and/or quality tools supported by UPMC Health Plan.
  • Works with the UPMC Health Plan internal team to identify and develop specific performance improvement strategies that will support a given Partner achieve performance goals.

 

Qualifications

  • Required:
  • Clinically-trained and/or demonstrated experience working in outpatient clinical settings
  • 5 years of experience in managed care and/or physician practice management required.
  • Experience with Medicare STARS, Medicaid HEDIS, and population health management.
  • Analytical and organization skills required.
  • Excellent written and verbal communication skills is required.
  • Preferred:
  • Drivers license and reliable transportation. 
  • Masters degree in a business or health care field.
  • Experience in Lean, Six Sigma, TQI, TQC, or other quality management certification.
  • Experience in network performance management and/or continuous quality improvement


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct