Quality Management Clinician - Hybrid

UPMC • Pittsburgh, PA

3h • Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a full-time Quality Management Clinician to join the Quality team. This is a hybrid role that will work onsite at downtown Pittsburgh's US Steel Tower or provider sites three days per week. This role will involve some local travel to providers within the Pittsburgh region. 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 (preference for Counseling, Social Work or related field) required.
• 3 years clinical experience required.
• Preference for behavioral health experience.
• Strong organizational and time management skills, with the ability to meet deadlines.
• Proficiency in report writing, Microsoft Excel, and managing large datasets.
• Ability to collaborate effectively with multidisciplinary staff and external providers.
• Demonstrated ability to analyze data and identify trends or areas for improvement.
• Demonstrates strong clinical knowledge of multiple behavioral health and substance use disorder services.

Nice To Haves

• Experience with quality management processes preferred.
• Familiarity with URAC, NCQA, and HEDIS standards preferred.
• Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, and/or licensed RN (with BSN) is a bonus.
• NCC certification is a bonus.

Responsibilities

• Conduct targeted clinical audits and focused quality studies.
• Support preparation for NCQA, URAC, and other regulatory or accreditation reviews.
• Monitor quality tracking reports, provide feedback to staff and committees, and aggregate data on a monthly basis.
• Analyze data to identify trends related to services and participating providers.
• Prepare monthly and quarterly quality improvement reports for Board review.
• Assist in developing and delivering training for providers, members, and staff as assigned.
• Participate in cross-departmental projects and initiatives as assigned by senior leadership (e.g., Chief Medical Officer, VP of Medical Affairs).
• Log and report individual and aggregate complaints and grievances; prepare formal reports and ensure timely follow-up and escalation to Quality Management leadership as appropriate.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level