Coordinator, Quality Improvement - Hybrid

UPMC•Pittsburgh, PA

9h•Hybrid

About The Position

The incumbent Coordinator, Quality Improvement is a valuable contributor to the Health Plan’s Quality Improvement Program, supporting various functions. This team member is one that enjoys the challenge of working independently but also has the ability to collaborate effectively across a wide variety of stakeholders. This position is heavily focused on assisting the Health Plan to achieve NCQA Health Plan Accreditation, LTSS Distinction, Health Outcomes Accreditation, and/or Community Focused Care Accreditation through effective project management skills. This focus on Accreditation requires the incumbent to have a strong ability to collect, abstract, and analyze data for purposes of advancing quality improvement initiatives and achieving the Health Plan’s goals of excellence. Additionally, responsibilities may include, but are not limited to, delegation oversight, committee support, performance monitoring and assessment, and provider education and improvement activities. This is a full-time position working Monday through Friday with a hybrid schedule, consisting of working from home and in office.

Requirements

Bachelors' degree in a health care field or equivalent work experience required.
5 years of health care experience is required.
Proficiency in Microsoft Word and Excel required; PowerPoint and Access proficiency preferred.
Excellent verbal, written and presentation skills are required.
Professionalism, enthusiasm and initiative are expected.
Ability to work independently and as productive team member is essential.
Knowledge of the National Committee on Quality Assurance (NCQA) Standards for the accreditation of managed care organizations

Nice To Haves

BSN or RN is preferred. Health related Masters is preferred.
HEDIS specifications; the managed care environment and the basic tenets of continuous quality improvement are strongly preferred
Experience with data collection, analysis and management is a plus.

Responsibilities

Assume accountability for assigned standards from the National Committee for Quality Assurance (NCQA), including oversight of delegated activities.
Collaborate with UPMC Health Plan departments, such as Marketing, Third Party Contracting, Legal, Network Management, Member Services, Claims Payment, Pharmacy Services, Utilization and Medical Management, Care Management, and Credentialing as well as delegates to ensure that NCQA standards are met and appropriate documentation is maintained.
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.
Conduct work within the time parameters and in accordance with UPMC Health Plan Policies and Procedures, the Health Plan's Quality Improvement Program 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.
Support the UPMC Health Plan Committee functions and activities, as assigned.
Ensure that meetings are organized, well-documented and that they meet the Health Plan goals and objectives as well as the individual Committee's roles and responsibilities.
Serve as subject matter expert in assigned area(s) of NCQA Accreditation by providing consultative support, education, and instruction to stakeholders to ensure adherence to accreditation standards.
Support the UPMC Health Plan Committee functions and activities, as assigned.
Ensure that meetings are well-organized, well-documented and that they meet the Health Plan goals and objectives as well as the individual Committee's roles and responsibilities.
Ensure that performance measurement analysis is accurate and sufficient to produce meaningful results.
Consult, guide, and instruct stakeholders on adherence to accreditation standards, HEDIS focused activities, and other quality improvement initiatives.
Participate in the Health Plan Effectiveness Data and Information Set (HEDIS) program, including data collection and abstraction, coordination of network provider education, HEDIS measure education, review of provider profiles, as well as planning and implementing improvement initiatives in accordance with the Department’s designated work plan.
Assume accountability for Centers for Medicare and Medicaid Services (CMS) and /or Pennsylvania Department of Human Services (DHS) annual review standards, including oversight of delegated activities, as assigned.
Work with UPMC Health Plan departments and delegates to ensure that the CMS and DHS standards and reporting requirements are met.
Demonstrate appropriate application of policies, procedures, and guidelines through continuous learning.
Assist with the coordinated responses to Requests for Information or Proposals for the UPMC Health Plan Business Development staff related to the Quality Improvement program.
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.
Other duties, as assigned.