Coordinator, Quality Improvement- Remote
UPMC Health Plan has an exciting opportunity for a Coordinator, Quality Improvement position. This is a full time position working Monday through Friday daylight hours and will be a remote position.
The Quality Improvement Coordinator position supports quality improvement and regulatory initiatives through coordination of chart chase, medical record abstraction, and year-round HEDIS review activities including the support of Natural Language Processing (NLP)-enabled abstraction strategies. This role ensures accurate and timely collection of clinical data, identifies documentation and performance trends, and supports organizational readiness for NCQA’s transition to digital quality measurement. These efforts contribute to improved HEDIS performance, CMS Star and NCQA Ratings, and overall health plan quality outcomes.
Responsibilities:
• 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.
• Work is conducted within the time parameters and in accordance with UPMC Health Plan Policies and Procedures, the Health Plan's Quality Improvement Description and Work Plan as well as the requirements and expectations of the 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 and the individual Committee's roles and responsibilities.
• Participate in the Health Plan Effectiveness Data and Information Set (HEDIS?) program, including data collection and abstraction, performing root cause analysis, designing and/or implementing improvement plans, and monitoring and reporting results in accordance with the department's designated work plan.
• Demonstrate appropriate application of policies, procedures, and guidelines through continuous learning. Ensure that performance measurement is sufficient to produce meaningful and accurate results. Council, guide and instruct Health Plan employees on adherence to accreditation standards, HEDIS focused activities and other quality improvement initiatives.
• 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.
• Coordinate and conduct network physician and staff education, initiatives related to HEDIS including HEDIS measure education, review of physician profiles and planning and implementation of improvement initiatives.
• 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 and the individual Committee's roles and responsibilities.
• Support and champion UPMC Health Plan safety initiatives as assigned.
Apply tot his job
Apply To this Job
The Quality Improvement Coordinator position supports quality improvement and regulatory initiatives through coordination of chart chase, medical record abstraction, and year-round HEDIS review activities including the support of Natural Language Processing (NLP)-enabled abstraction strategies. This role ensures accurate and timely collection of clinical data, identifies documentation and performance trends, and supports organizational readiness for NCQA’s transition to digital quality measurement. These efforts contribute to improved HEDIS performance, CMS Star and NCQA Ratings, and overall health plan quality outcomes.
Responsibilities:
• 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.
• Work is conducted within the time parameters and in accordance with UPMC Health Plan Policies and Procedures, the Health Plan's Quality Improvement Description and Work Plan as well as the requirements and expectations of the 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 and the individual Committee's roles and responsibilities.
• Participate in the Health Plan Effectiveness Data and Information Set (HEDIS?) program, including data collection and abstraction, performing root cause analysis, designing and/or implementing improvement plans, and monitoring and reporting results in accordance with the department's designated work plan.
• Demonstrate appropriate application of policies, procedures, and guidelines through continuous learning. Ensure that performance measurement is sufficient to produce meaningful and accurate results. Council, guide and instruct Health Plan employees on adherence to accreditation standards, HEDIS focused activities and other quality improvement initiatives.
• 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.
• Coordinate and conduct network physician and staff education, initiatives related to HEDIS including HEDIS measure education, review of physician profiles and planning and implementation of improvement initiatives.
• 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 and the individual Committee's roles and responsibilities.
• Support and champion UPMC Health Plan safety initiatives as assigned.
Apply tot his job
Apply To this Job