Job Description

Job Title: Director, CHC Operations
Job ID: 580093
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day
Facility:
Department: Community HealthChoices
Location: 600 Grant St, Pittsburgh PA 15219

Description

The Director Community Health Choices Operations will serve as a business lead for implementation and ongoing support of Community Health Choices and long term services and supports.  This position will assure fulfillment of contract obligations, serve as an operational liaison with internal stakeholders and clearly communicate plan design and product needs to the assigned staff.

 

The Director CHC Operations will provide leadership, guidance and direction to assigned staff.  [S]he will be responsible for developing and implementing best practices as they relate to CHC operations and line of business requirements. 

 

The Director works with a broad spectrum of UPMC Health Plan personnel and physician leaders to contribute to the development of the overall strategy of the Health Plan's CHC program. The Director also identifies plans, develops, and implements strategy for operational management and development to meet organizational performance plans within agreed upon budgets and timeframes.

 


Responsibilities:

  • Serves as key staff person in the implementation of CHC across PA zones  
  • Develop and maintain written documentation based on contract requirements
  • Assist with the facilitation of needed working groups throughout the post go-live process/period to identify problems and implement solutions.
  • Ensure that all required steps necessary to meet governmental and internal/external standards and regulations are met

  • Analyze and trend data to identify inefficiencies and implement process improvement

  • Identify areas of potential compliance risk and develop solutions for risk mitigation

  • Assist in the development/refinement of policies and procedures both internally and in partnership with external providers

  • Manages and directs staff, supporting professional growth by providing education, training and appropriate resources

  • Represent CHC operations on internal and external forums and committees as requested  

  • Collaborate with the UPMC Health Plan Marketing and Health Plan Communications departments to design effective, compliant, and timely marketing and member communications campaigns.

  • Contribute to the evaluation and development of operational strategy and performance in cooperation with the executive team.

  • Ensure activities meet with and integrate with government programs and organizational requirements for quality management, legal stipulations, and regulatory affairs.
  • Establish and maintain appropriate systems for measuring necessary aspects of program performance, and monitor operational performance of all supporting systems, including call center, member services, enrollment, revenue management, and reporting.
  • Identify, plan, develop, and direct the implementation of CHC business plans to achieve organization goals while supporting the overall compliance strategy
  • Liaise and meet regularly with functional/departmental directors of the Health Plan to assess all necessary aspects and needs of the operational development of CHC and to ensure full comprehension of objectives, purposes, and financial goals while adhering to compliance and regulatory standards.

Qualifications

  • Bachelor’s degree in business, health care or financial studies or related field required; Master’s degree preferred
  • 7 years of experience in health care or managed care setting primarily related to MLTSS programs required.
  • Excellent leadership skills
  • Excellent verbal and written communication skills. Analytical and organizational skills are required.
  • Extensive problem-solving experience is required.
  • Experience in development, implementation, and ongoing management of Medicare Advantage or Medicaid programs is essential.
  • Excellent managerial, analytical, organizational, and customer service skills are key.
  • The ability to continuously interact effectively with all levels of management is critical.

  • Must possess ability to develop and analyze business processes to develop operational processes. 
  • Must possess excellent troubleshooting and problem-solving skills; sense of urgency, responsiveness and judgment to make effective decisions is required.
  • Ability to work effectively across a large, highly matrixed and dynamic organization.
  • Must possess a strong attention to detail as well as the ability to think and plan strategically

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Union Position: No

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