← Serch more jobs

Quality Management Specialist - Hybrid

UPMC • Pittsburgh, PA

Not Applicable Posted April 17, 2026 Job link

Thinking about this job

Responsibilities

Commitments

Responsibilities

Prepares formal reports and tracks timing of various levels of report completion.
Responsible for specified data collection related to all functional departments of Community Care.
Responsible for tracking committee actions and outcomes for feedback to the appropriate individual/committee.
Responsible for preparing reports to be sent to cross contract oversight agencies.
Responsible for performing targeted audits.
Responsible for assisting with preparation for NCQA, URAC and other site visits.
Responsible for appropriate correspondence related to managing quality data.
Responsible for logging, tracking, monitoring, and reporting individual and aggregate reports to the Management staff of the Quality Management department, and other leadership staff as appropriate.
Responsible for written quality newsletters, and assisting with the provider and member newsletters as indicated.
Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff, and aggregating the data on a monthly basis.
Prepares weekly, monthly, quarterly, and annual reports and tracks timeliness of investigation and follow-up of identified significant member events.
Responsible to assist with tasks related to the Outcomes Department and other departments as assigned by quality management staff.
Responsible for participating in updating the QM Plan.
Responsible for identifying trends related to product and participating providers.
Responsible for minute taking at the Board Quality Improvement Committee and other quality committees as assigned.
Responsible for preparing monthly and quarterly quality improvement reports to the Board.
Ability to travel for 75% of the year

Not Met Priorities

What still needs stronger evidence

Requirements

Ability to travel for 75% of the year
Two years of clinical experience in a health or human services agency may be substituted for education requirements (CAC—Certified Addictions Counselor preferred).
Knowledge of Microsoft Word, Excel, and PowerPoint required.
Excellent organizational skills.
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, pertinent issues related to product and population served, and the operating practices of this organization.
Ability to identify trends or problem areas.
Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement.
Demonstrates clinical knowledge of behavioral health related issues.
Excellent clinical, written and oral communication skills.
Responsiveness to deadlines and has work completed on or before deadline 95% of the time.

Preferred Skills

Bachelor's Degree in Social Work or closely related field preferred, however, we will also consider candidates with prior behavioral health/substance use experience.
Experience in managed care preferred.
Two years of clinical experience in a health or human services agency may be substituted for education requirements (CAC—Certified Addictions Counselor preferred).
Experience in substance use disorder treatment preferred.
Experience in report writing and collection and organization of large quantities of data preferred.
Pennsylvania-approved ASAM training preferred, will be preferred within one year of hire
Pennsylvania Licensure and Certification preferred: LSW, LCSW, LPC, LMFT, RN, CAC.
Valid Pennsylvania Driver’s License preferred.

Education

(Not required) – Bachelor's Degree in Social Work or closely related field preferred, however, we will also consider candidates with prior behavioral health/substance use experience.
(Not required) – Two years of clinical experience in a health or human services agency may be substituted for education requirements (CAC—Certified Addictions Counselor preferred).
(Not required) – Pennsylvania Licensure and Certification preferred: LSW, LCSW, LPC, LMFT, RN, CAC.

UPMC Community Care Behavioral Health is hiring full-time Quality Management Specialists! These positions follow a hybrid schedule with on-site work at a Community Care office three days per week: Monday, Wednesday, and Thursday. Candidate may reside anywhere in PA or neighboring states and report to their nearest Community Care office (currently we have offices in Pittsburgh, Moosic, State College, Erie, Harrisburg and the Philadelphia area). This role will involve travel throughout Pennsylvania as well.
The Quality Management Specialist is responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC the Commonwealth of Pennsylvania Department of Health quality assurance regulations, and all other regulatory and oversight agencies.

Despite the pay range listed, the current budget for this position is $21.86/hr - $25/hr.
Responsibilities:

Prepares formal reports and tracks timing of various levels of report completion.
Responsible for specified data collection related to all functional departments of Community Care.
Responsible for tracking committee actions and outcomes for feedback to the appropriate individual/committee.
Responsible for preparing reports to be sent to cross contract oversight agencies.
Responsible for performing targeted audits.
Responsible for assisting with preparation for NCQA, URAC and other site visits.
Responsible for appropriate correspondence related to managing quality data.
Responsible for logging, tracking, monitoring, and reporting individual and aggregate reports to the Management staff of the Quality Management department, and other leadership staff as appropriate.
Responsible for written quality newsletters, and assisting with the provider and member newsletters as indicated.
Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff, and aggregating the data on a monthly basis. Prepares weekly, monthly, quarterly, and annual reports and tracks timeliness of investigation and follow-up of identified significant member events.
Responsible to assist with tasks related to the Outcomes Department and other departments as assigned by quality management staff.
Responsible for participating in updating the QM Plan.
Responsible for identifying trends related to product and participating providers.
Responsible for minute taking at the Board Quality Improvement Committee and other quality committees as assigned.
Responsible for preparing monthly and quarterly quality improvement reports to the Board.
Ability to travel for 75% of the year
Bachelor's Degree in Social Work or closely related field preferred, however, we will also consider candidates with prior behavioral health/substance use experience.
Experience in managed care preferred.
Two years of clinical experience in a health or human services agency may be substituted for education requirements (CAC—Certified Addictions Counselor preferred).
Experience in substance use disorder treatment preferred.
Knowledge of Microsoft Word, Excel, and PowerPoint required.
Excellent organizational skills.
Experience in report writing and collection and organization of large quantities of data preferred.
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, pertinent issues related to product and population served, and the operating practices of this organization.
Ability to identify trends or problem areas.
Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement.
Demonstrates clinical knowledge of behavioral health related issues.
Excellent clinical, written and oral communication skills.
Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
Pennsylvania-approved ASAM training preferred, will be preferred within one year of hire
Licensure, Certifications, and Clearances:

Pennsylvania Licensure and Certification preferred: LSW, LCSW, LPC, LMFT, RN, CAC.
Valid Pennsylvania Driver’s License preferred.
UPMC is an Equal Opportunity Employer/Disability/Veteran