Job Description

Job Title: Regional Medical Director (Physician) - UPMC Passavant & UPMC St. Margaret
Job ID: 721991
Status: Full-Time
Regular/Temporary: Regular
Hours: Daylight, Monday thru Friday
Shift: Day Job
Facility: UPMC Passavant
Department: Administration
Location: 9100 Babcock Blvd, Pittsburgh PA 15237

Description

Are you a seasoned physician with a passion for community care? Do you enjoy working in a collaborative medical team? Do you have an interest in the administrative side of medicine? Consider this rare opportunity!

This position will work standard daylight hours Monday through Friday.

UPMC Passavant, together with UPMC St. Margaret, seeks a full-time Regional Medical Director to support our hospitals' community care and care management programs. This position will be physically based at UPMC Passavant in McCandless Township, located within the North Hills area of Pittsburgh.

UPMC St. Margaret is a 249-bed acute care and teaching hospital situated on a 21-acre campus near Aspinwall (Pittsburgh). It begins its second century of service with renewed dedication to more than 250,000 residents of northeastern Allegheny County and the Alle-Kiski Valley, providing residents convenient access to the area’s finest physicians and health services. UPMC St. Margaret also includes our affiliated outpatient centers in the surrounding area.

UPMC Passavant serves as UPMC’s tertiary care center north of Pittsburgh, bringing UPMC’s brand of world-class medical care to two convenient campuses in McCandless and Cranberry Townships to serve the communities and counties north of the city. Advanced, high-quality care and all of the resources of an academic medical center are available closer to residents north of Pittsburgh.

Both UPMC St. Margaret and UPMC Passavant are Magnet designated hospitals. Magnet status is one of the the highest achievements an organization can obtain for nursing excellence and leadership. Only 6.8 percent of hospitals nationwide have received Magnet status.

The Regional Medical Director is responsible for assuring the quality and efficiency of the health care delivered to Community Care members.  As Regional Medical Director, you will have the significant responsibility for quality management and utilization management, and for assuring the adequacy of the provider network for the clinical needs of Community Care members. You will participate in regional leadership policy decisions and strategic planning. In addition, you will serve as a resource to participating providers in the provision of quality medical care.

Does this sound like the career opportunity you've been looking for? Apply today to network with our team!

Responsibilities:
  • Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
  • Acts as a physician reviewer for cases referred by care management staff.
  • Advises the Regional Director on the development and review of programs, positions, and budgets having an impact on clinical services.
  • Assures effective and appropriate utilization of the various levels of care in the provider network
  • Assures the quality of treatment and related services provided by Community Care professional staff, through participation (directly or by designee) in the ongoing quality management and audit processes.
  • Develops and maintains effective relationships with providers.
  • Effectively reduce observation rates, length of stay, and readmission rates
  • Ensures the quality of clinical care provided to Community Care members
  • Focus on clinical documentation improvement efforts thereby improving reimbursement rates
  • Focus on quality and utilization from a regional perspective to include UPMC Passavant and UPMC St. Margaret.
  • Implements quality management programs and continuing education activities.
  • Interfaces with physician consultants and provides direction for the physician consultants. Interfaces with the Physical Health MCO's through Medical Director to Medical Director meetings, and sits on appropriate committees of the PH MCOs.
  • Interfaces with the Counties and DPW as indicated
  • Meets or exceeds NCQA, URAC or other regulatory standards
  • Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee
  • Reviews of complaints and grievances in accordance with Community Care procedures, and to assure prompt response and action at all stages of the complaint and grievance process.
  • Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
  • Serve as advisor to quality departments from a regional perspective
  • Serves as physician advisor for UPMC Passavant McCandless and UPMC Passavant Cranberry and serves as a backup for other business units
  • Supports member satisfaction with the care management process
  • Work in tandem with the UPMC Health Plan
  • Works closely with the medical directors of physical health HMO's to assure coordination between physical health and behavioral health needs and services
  • Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network.
  • Works with Quality Management in designing and evaluating protocols.

Qualifications

  • Minimum 10 years clinical experience.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school. 
  • Unrestricted License in Pennsylvania.
  • Post residency clinical experience
  • Previous management experience preferred.
  • Experience in managed care setting preferred
  • Ability to implement medical policies, and to enforce those policies through appropriate action.
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.
  • Ability to implement programs of quality care analysis, peer review, and professional education.
Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance with Renewal
  • Medical Doctor
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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