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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.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Quality Improvement Supervisor

  • Job ID: 265512306
  • 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: $33.86 to $57.80 / hour

Description

UPMC Health Plan is hiring a full-time Quality Improvement (QI) Supervisor for its National Committee for Quality Assurance (NCQA) Accreditation team. This role will work standard daylight hours Monday through Friday. The team is based out of downtown Pittsburgh's US Steel Tower, however, this role may work remotely or in a hybrid structure. 

The Supervisor will oversee daily operations related to NCQA Accreditation, which may include supervising members of the QI NCQA team. While the Supervisor's primary area of focus will be related to ensuring compliance with the National Committee for Quality Assurance, he or she will also operate in accordance with applicable Department of Health (DOH), Department of Human Services (DHS), and the Centers for Medicare and Medicaid Services (CMS) requirements.

Responsibilities:

 

  • Support or assume accountability for assigned standards from the National Committee for Quality Assurance (NCQA). Work with UPMC Health Plan departments, such as Marketing, Contracting, Network Relations, Member Services, Clinical Operations, Pharmacy Services, Utilization and Medical Management, Prevention and Wellness Services, Credentialing and other departments to ensure that NCQA standards are met and appropriate documentation is maintained.
  • Work on the completion of NCQA readiness assessment activities, as assigned, and gap identification.
  • Review documentation compiled to comply with the requirements of the NCQA Standards for Health Plan Accreditation, Health Equity Accreditation, and LTSS Distinction as part of the annual readiness assessment process.
  • Coordinates oversight of delegated QI and NCQA-related activities, including involvement with required workgroups and committees involving delegation oversight of applicable vendors.
  • Demonstrate ability to conduct and create reports documenting quantitative and qualitative analysis, including identification of barriers, opportunities for improvement, and proposed interventions through collaboration with others within the QI team or other UPMC Health Plan departments.
  • Council, guide and instruct Health Plan employees on adherence to accreditation standards and other NCQA-related quality improvement initiatives.
  • Support UPMC QI committees, subcommittees and/or work group functions and activities, as assigned. Ensure that meetings are organized, well documented and that they meet the Health Plan and/or NCQA goals and objectives and the individual committee's roles and responsibilities. In some situations, this may include chairing the meetings.
  • Oversight of policy compliance, as assigned, which may include participation in the policy review committee.
  • Demonstrate appropriate application of policies, procedures, and guidelines through continuous learning.
  • Participation in QI special projects or initiatives, such as provider surveys or developing training materials.
  • 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 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 and accreditation agencies.
  • 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.
  • Support and champion UPMC Health Plan safety initiatives, as assigned.
  • Supervisory activities over applicable staff.
  • Primary preceptor for new hires joining the team.
  • Other activities related to the NCQA, including (but not limited to), the Standards for Health Plan Accreditation, Health Equity Accreditation, and Long-Term Services and Supports (LTSS) Distinction, as required.

 

Qualifications

  • Bachelor's degree in business, health care, management or a related field, or equivalent relevant experience preferred.
  • 4 years (or more) of experience with NCQA Health Plan Accreditation Standards preferred.
  • Experience with the NCQA Long-Term Services and Supports (LTSS) and Multicultural Health Care (MHC) Standards for Distinction a plus.
  • Supervisory experience a bonus
  • High degree of professionalism, enthusiasm and initiative on a daily basis.
  • Ability to work in an environment that has time-sensitive deliverables is a must.
  • Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department and with other departments.
  • Attention to detail, strong organizational, communication, planning, analytical and problem-solving skills are critical to the success of this position.
  • Skills with MS Office suite products.
  • Experience with a managed care transactional system preferred.


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UPMC is an Equal Opportunity Employer/Disability/Veteran

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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