Top 14 Quality coordinator Jobs in Bethel Park, Pa

Quality of Care Clinical Coordinator I (RN) - Hybrid
UPMC - Pittsburgh Medical Center —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
3d
Clinical Quality Coordinator
Southwood Children's Behavioral Healthcare —Pittsburgh, PA
- Full-time
- CPR Certification
- Nursing
- Management
Mortgage Quality Control Coordinator
SingleSource Property Solutions —Canonsburg, PA
- $20 - $22 an hour
- Full-time
- Hybrid work
- Background check
- Mid-level
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
Quality Control Coordinator (Field Services)
SingleSource Property Solutions —Canonsburg, PA
- $23 an hour
- Mid-level
- Communication skills
- 401(k)
- Paid time off
Quick Apply
Quality Coordinator
Mondi —Clinton, PA
- Mid-level
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
Quality Improvement Coordinator
Allegheny County Pennsylvania —Allegheny County, PA
- $54,474 a year
- Online Application
- Background check
- Nursing
- Writing skills
Quality of Care Clinical Coordinator I (RN) - Hybrid
UPMC —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
3d
Laboratory Coordinator
Terracon —Pittsburgh, PA
- Mid-level
- High school diploma or GED
- Driver's License
- Paid holidays
- Health insurance
Research Coordinator
UPMC —Pittsburgh, PA
- $27.89 - $48.21 an hour
- Full-time
- Master's degree
- Administrative experience
- Surgery
8d
Quality and Training Coordinator, OGI Center of Excellence
Alliance Technical Group —United States
- $60,000 - $90,000 a year
- Weekends as needed
- Classroom
- Microsoft Outlook
- Up to 50% travel
- Travel reimbursement
- Profit sharing
Quick Apply

More jobs to discover

Find similar jobs that you might be interested in.

Quality of Care Clinical Coordinator I (RN) - Hybrid
UPMC - Pittsburgh Medical Center —Pittsburgh, PA
Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60…
$32.85 - $56.83 an hour
3d
Clinical Quality Coordinator
Southwood Children's Behavioral Healthcare —Pittsburgh, PA
Ensures operational implementation of regulatory requirements, guidelines, and standards of federal, state, and local licensing agencies, accrediting and…

Show more similar jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Quality Coordinator
Menasha Corporation & Companies —West Jefferson, OH
Conducts and documents quality testing to meet required customer, company or industry specifications while complying with applicable federal, state and local…
18h
Quality Control Coordinator
Cart.com, Inc. —Groveport, OH
Basic math and measurement skills; ability to use measuring tools such as rulers and tape measures. Compare finished products to approved samples and technical…
Quick Apply

Show more jobs in cities nearby

I want to receive the latest job alert for quality coordinator in bethel park, pa

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

quality coordinator jobs near bethel park, pa

Research Coordinator jobs in Pittsburgh, PA

Quality Coordinator jobs in Pittsburgh, PA

Clinical Care Coordinator jobs in Pittsburgh, PA

Laboratory Manager jobs in Pittsburgh, PA

Project Coordinator jobs in Salt Lake City, UT

Clinic Coordinator jobs in Remote

Quality Coordinator jobs in San Jose, CA

Quality Coordinator jobs in Texas

Nonprofit Coordinator jobs in Seattle, WA

Quality Coordinator jobs in Longmont, CO

Quality Coordinator jobs in Portland, OR

Research Coordinator jobs in Kalamazoo, MI

Research Coordinator jobs in University Of South Florida, FL

Research Scientist jobs in Orlando, FL

Research Coordinator jobs in Denton, TX

Research Coordinator jobs in New Brunswick, NJ

Psychology Research Assistant jobs in Connecticut

Quality Coordinator jobs in Malvern, PA

Quality Coordinator jobs in Phoenix, AZ

Quality Coordinator jobs in Fort Wayne, IN

Quality of Care Clinical Coordinator I (RN) - Hybrid

UPMC - Pittsburgh Medical Center -
Pittsburgh, PA

Apply Now

Job Details

Full-time
$32.85 - $56.83 an hour
3 days ago

Qualifications

Direct patient care
RN License
Computer skills
Patient treatment

Full Job Description

UPMC Health Plan is hiring a full-time Quality of Care Clinical Coordinator I to join the Quality Improvement team. This role will predominantly work remotely but will require in office presence once a month in downtown Pittsburgh's US Steel Tower.

This position coordinates and completes quality-of-care investigations, ensuring timely and compliant resolution across all intake channels. Manages multiple cases concurrently, conducts data analysis to identify quality improvement opportunities, and collaborates with Medical Directors and cross-functional teams through case review, documentation, administrative determinations, and case closure. This role supports regulatory compliance across all lines of business within the Quality Improvement department.

Responsibilities:

Review, investigate, and complete case investigation related to quality-of-care concerns in required timeframes.
Work closely with Special Investigations Unit (SIU), Network, Claims, Community Care Behavioral Health, Provider Services, Member Services, Medical Management, and Pharmacy Services to ensure review processes are understood and meet Health Plan strategy for appropriateness of quality-of-care referrals.
Manage escalated member and provider issues as required.
Review referrals for quality-of-care concerns, completes a comprehensive investigation summarizing clinical facts for the Medical Director review.
Coordinates timely case review by a Health Plan Medical Director.
Create correspondence for review prior to finalizing outreach to providers as needed to obtain and review additional clinical documentation, as well as provider and/or facility responses.
Interpret Medical Director notes and summarize into correspondence for provider and/or facility.
Report trends to leadership for improvement opportunities and provider education.
Prepare documentation and summary for physician consultant peer review packets for designated specialized cases (i.e., pediatric neurosurgery) outline case and peer review needs
Outreach to providers as appropriate to communicate decision.
Collaborate with health plan business partners, as appropriate, for referral of investigation
Build and foster collaborative relationships with internal and external stakeholder
Assist in the creation, enhancement, and implementation of process workflows for the QI, QOC Department.
Assist with identifying continuing education needs and opportunities; maintain continuing education and appropriate CEUS required for RN licensure.
Participate in quality improvement initiatives as assigned

Registered nurse with a minimum of two years direct patient care experience required. PA RN license preferred.
Two years of Health Insurance experience as a Registered Nurse in a Utilization Management/Medical Management/Care Management role strongly preferred.
BSN is a bonus.
HEDIS knowledge is a bonus.
Experience with accountability for regulatory compliance for entities such as NCQA, CMS, Department of Public Welfare, Department of Health, and/or Pennsylvania Insurance Department preferred.
Excellent verbal and written communications skills required.
The ability to work in a fast-paced insurance environment and to manage multiple priorities/projects in a professional manner required.
Working knowledge of ICD-9/ICD-10 and CPT classifications and coding of diagnoses and procedures preferred.
Proficiency in computer skills required.
Ability to collaborate effectively with physicians and other health care professionals.
Strong organizational and critical thinking skills with ability to make decisions independently.

Licensure, Certifications, and Clearances:
Registered Nurse (RN)
Act 34
Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

UPMC is an Equal Opportunity Employer/Disability/Veteran

Apply Now

Refine Your Search

quality coordinator jobs in bethel park, pa

Quality of Care Clinical Coordinator I (RN) - Hybrid

Clinical Quality Coordinator

Mortgage Quality Control Coordinator

Quality Control Coordinator (Field Services)

Quality Coordinator

Quality Improvement Coordinator

Quality of Care Clinical Coordinator I (RN) - Hybrid

Laboratory Coordinator

Research Coordinator

Quality and Training Coordinator, OGI Center of Excellence

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for quality coordinator in bethel park, pa

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected