Quality Management Clinician (Hybrid)

UPMC Community Care Behavioral Health is hiring a full-time Quality Management Clinician to join the Quality team. This role will work in a hybrid structure with 3 days in the office in Tobyhanna each week. Occasional local travel may be needed at times.

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.