Director of Q1 MA, SNP, CHIP

Company: UPMC Location: Pittsburgh, PA Status: Full Time, Employee Job Category: Medical/Health Career Level: Manager (Manager/Supervisor of Staff) Company: UPMC Reference Code: Job ID: 1032754UPMC is an integrated global health enterprise headquartered in Pittsburgh, Pennsylvania, and one of the leading non-profit health systems in the United States. As western Pennsylvania’s largest employer, with 48,000 employees and nearly $7 billion in revenue, UPMC is transforming the economy of the region into one based on medicine, research, and technology. By integrating 20 hospitals, 400 doctors’ offices and outpatient sites, long-term care facilities, and a major insurance plan, UPMC has advanced the quality and efficiency of health care and developed internationally renowned programs in transplantation, cancer, neurosurgery, psychiatry, orthopedics, and sports medicine, among others. UPMC is commercializing its medical and technological expertise by nurturing new companies, developing strategic business relationships with some of the world’s leading multi-national corporations, and expanding into international markets; including Italy, Ireland, the United Kingdom, and Qatar. For more information about UPMC, visit our website at www.upmc.com. Director of Q1 MA, SNP, CHIP The UPMC Health Plan located in downtown Pittsburgh is seeking a director, quality improvement.  This position reports to the senior director, program development for Medicaid, Special Needs Plan (SNP) and Children's Health Insurance Program (CHIP).  This position is responsible for the design, implementation, oversight, and measurement of the effectiveness of the quality improvement interventions related to HEDIS measures for each of these products.  The scope of this position also includes the quality management and improvement of all aspects of both care and service delivered in all settings related to clinical programs for these products.  This position will be responsible for monitoring and collecting information related to clinical program performance, reviewing performance against goals and developing recommendations for improvement.  The director, quality improvement collaborates with the Medicaid, SNP and CHIP finance staff to develop performance goals related to any pay for performance programs.  This individual ensures provider pay for performance programs, member incentives, and Health Plan clinical interventions are designed to maximize the rates for measures included in these performance plans.  Requirements include a bachelor's degree in a health related field (master's preferred), three years of quality management experience in a managed care environment, including HEDIS, proficiency in utilizing PC based system applications for analysis, reporting and presentation purposes (knowledge of comparative databases such as Medisgroups, HC4, etc.), and excellent communication (verbal and written) and presentation skills.  Demonstrated knowledge and experience with clinical quality management and improvement concepts, techniques, processes and outcome measures and well developed analytical and problem-solving skills with the ability to interpret and summarize clinical data are also required.  The incumbent must have the ability to develop goals, action plans and contingency plans, identify information resource requirements, organize resources, establish and communicate expectations and manage multiple tasks simultaneously.  Knowledge of and/or experience with regulatory requirements for the delivery of health plan products, including Medicaid, Medicare, and CHIP models and proven success with direct supervision and management of staff and resources is also required. Direct experience with NCQA accreditation for managed care organizations and a valid RN license are preferred.   Apply at www.upmc.com by following these steps; click Careers at UPMC, Start My Job Search, and follow the link to continue to search and apply for openings. Select Advanced Search and enter 1032754 in the job opening ID field.  UPMC is an equal opportunity employer.