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Quality Management Clinician - Hybrid, UPMC

Job

UPMC

Remote

Full-Time

Posted 6 days ago (Updated 5 days ago) • Actively hiring

Expires 7/11/2026

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Job Description

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.
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.