Quality Assurance Focused Review Coordinator- Hybrid- Located in Pittsburgh, PA

UPMC Health Plan is hiring a full-time Quality Assurance  Focused Review Coordinator to help support the HPLAN-Quality Assurance and Operational department.  

Together with the QA Director they will coordinate external audits, including but not limited to, defining the scope and verifying requirements/deliverables, coordinating all aspects of onsite visits, coordinating document requests and audit responses.  Participates in/completes complex/special projects as needed by Management.  Implements process improvement initiatives based on management decisions.  Develops and maintains detailed project plans. Includes utilizing standard project documentation and methodology and project tracking and reporting procedures. Provides concise and timely status reporting as required. Develops and utilizes key metrics to measure and report on progress of initiatives. Assists team members in resolving project problems, escalates issues when necessary, and facilities decision-making.  Monitors health plan operating performance against regional and national benchmarks.  Performs cost/benefit analysis if needed. Assist with achieving Operations division strategic goals as well as health plan strategic goals. Works with other managers to achieve efficiencies across integration of projects.
 

This is a full time position working Monday through Friday daylight hours and will be a hybrid position consisting of working from home and in office.  Must be located in or around Pittsburgh, PA to be considered. 

Responsibilities:

• Projects 
• Define and develop overall objectives, scope and work plan and review and confirm with internal and external clients utilizing standard project management.
• External Audits 

• Coordinate external audits of the company: 

  Define the scope and verify requirements/deliverables Determine/identify/notify departments for participation in the audit.

• Create audit checklist based upon the type of audit and the requirements (i.e. Claim audit, Regulatory, Employer group, Financial, etc.). 

  Coordinate all aspects of onsite visit if applicable (building security, conference rooms, scheduling meeting dates/times, department tour, etc.). Coordinate universe, documentation requests, etc. and create folders and track audit progress. 

  Make appropriate entries into external audit database to aid in tracking and reporting.

   

• Coordinate audit responses.
• Follow up on audit compliance items

• Maintains Project Reporting Database - manage project inventory. 

  Build follow-up mechanism/maintenance plan.

• Demonstrate ability to prepare sensitive information and communicate it directly to senior management.
• Support the QA department's functions and activities assigned. Ensure that meetings are organized, well-documented.

• Prioritize tasks based on relative importance and urgency and identify dependencies across projects. 

  Recognize and act decisively in urgent matters; make tough decisions which may influence the direction of the project. 

• Direct and execute creative analytic approaches/ create new or adapt existing analytical methods and tools to solve problems.
• Cooperate closely with business leaders and/or management. Identify and mitigate business risks associated with projects.
• Dynamically lead presentations / work sessions to positively influence decisions and perceptions.
• Plan, organize and control multiple responsibilities and solicit participation from cross-functional resources and ensure that the most appropriate resources are assigned to specific project roles.
• Establish a mentoring environment.
• Plan and execute communication of complex information to team members and stakeholder groups.

• Bachelor's degree in business, mathematics, statistics, health care, management, or a related field required.
• Master's degree preferred. (extensive related experience will be considered)
• 3 years' experience in project management, and/or financial or healthcare analysis required.
• Experience in health care insurance or health care industry preferred.
• Strong computer skills, with proficient knowledge in MS Office and other financial & statistical software packages.
• Ability to work independently and as productive team member is essential.
• Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
• Attention to detail is critical to the success of this position.
• Strong problem solving, organizational, and communication skills (oral and written) are required. 
• Excellent Project Management skills along with effective planning. 
• Ability to perform planning for large initiatives/projects, managing all tasks required to provide services to meet client and business need within targeted deadlines. 
• Ability to effectively approach problem solving.
•  to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.
  
  Licensure, Certifications, and Clearances:
   
• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran