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Quality Management Specialist
Quality Management SpecialistUPMC • Pittsburgh, PA, US
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Quality Management Specialist

Quality Management Specialist

UPMC • Pittsburgh, PA, US
[job_card.30_days_ago]
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  • [job_card.full_time]
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Quality Management Specialist

UPMC Community Care Behavioral Health is hiring full-time Quality Management Specialists! This position involves extensive travel throughout Pennsylvania, with remote work available during non-travel periods. Candidates may reside in PA, OH, MD, NY, NJ or WV. The selected candidate would need to reside within 2 hours of a CCBH office location.

The Quality Management Specialist is responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC the Commonwealth of Pennsylvania Department of Health quality assurance regulations, and all other regulatory and oversight agencies.

  • Despite the pay range listed, the current budget for this position is $21.86 / hr - $24 / hr.

Responsibilities :

  • Prepares formal reports and tracks timing of various levels of report completion.
  • Responsible for specified data collection related to all functional departments of Community Care.
  • Responsible for tracking committee actions and outcomes for feedback to the appropriate individual / committee.
  • Responsible for preparing reports to be sent to cross contract oversight agencies.
  • Responsible for performing targeted audits.
  • Responsible for assisting with preparation for NCQA, URAC and other site visits.
  • Responsible for appropriate correspondence related to managing quality data.
  • Responsible for logging, tracking, monitoring, and reporting individual and aggregate reports to the Management staff of the Quality Management department, and other leadership staff as appropriate.
  • Responsible for written quality newsletters, and assisting with the provider and member newsletters as indicated.
  • Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff, and aggregating the data on a monthly basis. Prepares weekly, monthly, quarterly, and annual reports and tracks timeliness of investigation and follow-up of identified significant member events.
  • Responsible to assist with tasks related to the Outcomes Department and other departments as assigned by quality management staff.
  • Responsible for participating in updating the QM Plan.
  • Responsible for identifying trends related to product and participating providers.
  • Responsible for minute taking at the Board Quality Improvement Committee and other quality committees as assigned.
  • Responsible for preparing monthly and quarterly quality improvement reports to the Board.
  • Ability to travel for 75% of the year

    • Qualifications :

  • Bachelor's Degree preferred.
  • Experience in managed care preferred.
  • Two years of clinical experience in a health or human services agency may be substituted for education requirements (CACCertified Addictions Counselor preferred).
  • Experience in substance use disorder treatment preferred.
  • Knowledge of Microsoft Word, Excel, and PowerPoint required.
  • Excellent organizational skills.
  • Experience in report writing and collection and organization of large quantities of data preferred.
  • 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, pertinent issues related to product and population served, and the operating practices of this organization.
  • Ability to identify trends or problem areas.
  • Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement.
  • Demonstrates clinical knowledge of behavioral health related issues.
  • Excellent clinical, written and oral communication skills.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
  • Pennsylvania-approved ASAM training preferred, will be preferred within one year of hire

    • Licensure, Certifications, and Clearances :

  • Pennsylvania Licensure and Certification preferred : LSW, LCSW, LPC, LMFT, RN, CAC.
  • Valid Pennsylvania Driver's License preferred.

    • UPMC is an Equal Opportunity Employer / Disability / Veteran

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