Quality of Care Clinical Coordinator I (RN) - Hybrid

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, Com...

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