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UPMC Community Care Behavioral Health is seeking a full-time Quality Management Clinician to support the Quality Department in their Southeast Pennsylvania territory!

The Quality Management Clinician will work daylight hours, Monday through Friday, in a hybrid work structure! The home office for this position is based in Media, PA (with a partnering office in Exton, PA), and involves a combination of time in the office, in the field at provider sites, and working remotely from home. Travel requirements ebb and flow due to business needs, but the Quality Management Clinician’s territories will include Chester County, Delaware County, and surrounding counties.

Community Care Behavioral Health (CCBH) is committed to giving our neighbors the quality of life that they deserve. A proud part of the UPMC Insurance Services Division, CCBH provides members with the behavioral health treatment that they need for better health and a higher quality of life, including treatment for mental health conditions, drug or alcohol addiction, and developmental disabilities.

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. Along with record reviews and audits, this role will work directly with providers and provider sites to provide support.

**As part of the application, a cover letter is strongly encouraged.

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.

+ Licensed Registered Nurse (BSN is a bonus) or Masters Degree (licensure is a bonus).

+ 3 years clinical experience.

+ Behavioral health experience is highly preferred

+ Experience in Quality Management procedures/processes preferred. Knowledge of URAC, NCQA and HEDIS standards preferred.

+ Experience in managed care preferred.

+ 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% of the time. **Licensure, Certifications, and Clearances:**

+ Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred. **UPMC is an Equal Opportunity Employer/Disability/Veteran**