UPMC Health Plan is hiring a full-time Quality Improvement Operations Specialist, Lead to join the Quality Improvement team. The team is based out of downtown Pittsburgh US Steel Tower, and this role will work in a hybrid structure with 3 days in the office per week – Monday, Wednesday, and Thursday.
The QI Operations Specialist Lead serves as a departmental subject matter expert responsible for leading the planning, implementation, and ongoing management of complex quality improvement initiatives that support organizational priorities, regulatory requirements, and performance goals. This position drives operational execution of quality improvement strategies through project leadership, vendor oversight, stakeholder engagement, process improvement, and performance monitoring. The incumbent partners closely with operational leaders, providers, vendors, and cross-functional teams to implement improvement initiatives, remove barriers to execution, and achieve measurable outcomes. The QI Operations Specialist Lead independently manages highly visible, complex initiatives with broad organizational impact and serves as a trusted resource for operational problem-solving, program implementation, and continuous improvement efforts.
Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status. UPMC does not participate in STEM OPT.
Responsibilities:
- Vendor & Partner Management• Serve as the primary operational lead for assigned vendor relationships supporting quality improvement activities.• Monitor vendor performance, deliverables, contractual commitments, and service-level expectations.• Coordinate implementation activities, issue resolution, process enhancements, and ongoing optimization efforts with external partners.• Collaborate with vendors and internal stakeholders to identify opportunities to improve operational effectiveness, user experience, and quality outcomes.• Support evaluation, onboarding, implementation, and management of quality-focused vendor solutions and technologies.
- Program Implementation & Performance Improvement• Lead implementation of new programs, workflows, processes, and operational capabilities that support quality improvement objectives.• Facilitate process and/or program redesign efforts utilizing established quality improvement and performance improvement methodologies.• Develop and maintain project plans, implementation timelines, workplans, and accountability structures.• Coordinate activities required to achieve organizational quality targets and improvement goals.• Track initiative progress and facilitate resolution of barriers impacting implementation and/or re-design success.
- Stakeholder Engagement & Collaboration• Build strong partnerships with operational leaders, clinical teams, provider-facing teams, compliance, technology partners, vendors, and other stakeholders.• Influence stakeholders across departments to support implementation and adoption of improvement initiatives.• Prepare and deliver progress updates, recommendations, implementation plans, and operational reports for leadership.• Participate in organizational committees, workgroups, and special projects as assigned.• Serve as a resource for best practices related to quality improvement, operational execution, and program implementation/re-design.
- Continuous Improvement• Promote a culture of continuous improvement through structured problem-solving, stakeholder engagement, and operational accountability.• Identify opportunities to simplify workflows, reduce barriers, improve performance, and enhance the effectiveness of quality improvement programs.• Support development, re-design, and implementation of sustainable operational processes that improve long-term performance.
- Environment• Quality Improvement is a dynamic, fast-paced environment. The successful employee is comfortable navigating ambiguity, managing multiple priorities, building collaborative relationships, and leading complex initiatives from planning through implementation.
- Bachelor's degree in Healthcare Administration, Public Health, Business, Nursing, Health Informatics, or a related field required.
- Master's degree is a bonus. .
- Minimum of 5 years of experience in healthcare operations, quality improvement, program management, vendor management, performance improvement, or a related field
- Prior experience in quality improvement or working within an insurance provider preferred.
- Experience with Epic, Cotiviti, Novillus or Astrata is a bonus.
- Proficiency with Microsoft Office suite preferred.
- Demonstrated experience leading complex cross-functional initiatives and driving operational implementation and/or re-design.
- Experience managing vendor relationships, operational programs, or large-scale improvement efforts preferred.
- Strong project and program management skills
- Strong operational planning, monitoring, and execution capabilities.
- Experience leading process improvement and change management initiatives.
- Ability to influence stakeholders without direct authority.
- Strong facilitation, communication, and relationship-management skills.
- Ability to manage multiple complex initiatives simultaneously.
- Knowledge of healthcare quality programs and performance improvement methodologies such as PDSA.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran