Quality Management Clinician (Hybrid)

UPMC•Tobyhanna, PA

4h•Hybrid

About The Position

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.

Requirements

Licensed Registered Nurse or Masters Degree required
3 years clinical experience required.
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 related to 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%25 of the time.

Nice To Haves

Prior behavioral health/mental health experience or education strongly preferred.
Experience in Quality Management procedures/processes is a bonus.
Knowledge of URAC, NCQA and HEDIS standards is a bonus.
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) is a bonus.

Responsibilities

Participating in projects as designated by other management staff, such as the Chief Medical Officer and VP of Medical Affairs.
Performing targeted, clinical audits and focus studies.
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.
Assisting with preparation for NCQA, URAC, and other site visits.
Participating in updating the QM Plan.
Monitoring quality tracking reports and providing individual feedback to appropriate staff/committees, and aggregating the data on a monthly basis.
Identifying trends related to product and participating providers.
Preparing monthly and quarterly quality improvement reports to the Board.
Specified data collection related to all functional departments of Community Care.
Assisting with training responsibilities for providers, Members, and staff on various issues as assigned by the Senior Director of Quality Management.
Professional and staff development plan.