What are the responsibilities and job description for the Quality Management Specialist - Hybrid position at UPMC?
UPMC Community Care Behavioral Health is hiring full-time Quality Management Specialists! These positions follow a hybrid schedule with on-site work at a Community Care office three days per week: Monday, Wednesday, and Thursday. Candidate may reside anywhere in PA or neighboring states and report to their nearest Community Care office (currently we have offices in Pittsburgh, Moosic, State College, Erie, Harrisburg and the Philadelphia area). This role will involve travel throughout Pennsylvania as well.
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 - $25/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