Description
UPMC has an exciting opportunity for a Quality Management Clinician within Community Care Behavioral Health (CCBH)! This is a regular, full time position with hybrid work arrangements and travel needed for field work and some in-office duties.
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 relatedto 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.
- Act 31 Child Abuse Reporting with renewal
- Act 33 with renewal
- Act 34 with renewal
- 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.
