Provider Network & Quality Improvement Liaison

UPMC; Camp Hill (Cumberland County); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Mileage reimbursement

Job summary

UPMC Health Plan is seeking a Provider Network Liaison to serve as the primary relationship manager for assigned physician practices, specialty providers, and hospital systems across Central Pennsylvania. In this hybrid role, you will be the main point of contact to help navigate operational needs and advance quality improvement initiatives.

You will collaborate with physicians, practice administrators, and health plan leaders to implement value-based care strategies, monitor performance, and

Qualifications

• Bachelor's degree in business or healthcare is required.
• Master's degree preferred.
• 5 years of managed care/physician practice management experience required.
• Experience with Medicare STARS and Medicaid HEDIS is desirable.
• Excellent written and verbal communication skills are required.
• Ability to interact effectively with all Health Plan departments is critical.
• Experience in network performance management or continuous quality improvement is a plus.

Responsibilities

• Acts as the on-site quality improvement champion, coordinating efforts across field-based initiatives.
• Identify and develop performance improvement strategies to help Partners achieve goals.
• Collaborate with Partners to implement improvement strategies with the internal UPMC Health Plan team.
• Manage information to track progress on value-based reimbursement plans for Partners where applicable.
• Distribute provider reports and lead development of action plans.
• Assist Partners in workflow redesign and data-driven decision making to meet performance goals.
• Apply continuous quality improvement methodologies to drive change.
• Serve as subject matter expert on quality (Medicare STARS, HEDIS) and support practices accordingly.
• Provide assistance to Partners and staff using UPMC Health Plan quality tools and interfaces.
• Support daily operational issues including claims and network inquiries; triage as needed.

Skills

Verbal communication

Written communication

Interpersonal skills

Education

Bachelor's degree in business or healthcare

Master's degree

Job description

UPMC Health Plan is seeking a Provider Network Liaison to serve as the primary relationship manager for assigned physician practices, specialty providers, and hospital systems across Central Pennsylvania. In this hybrid role, you will be the main point of contact to help navigate operational needs and advance quality improvement initiatives.

You will collaborate with physicians, practice administrators, and health plan leaders to implement value-based care strategies, monitor performance, and