COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Actuarial Value-Based Contracting Manager (REMOTE, US)

Description

UPMC Health Plan's Actuary Team is seeking a Manager of Value-Based Contracts!

This person ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of provider relations, contracting and forecasting.  Responsible for supervising actuarial analysts.  Presents to senior financial leadership.  Participates in the design and negotiation of new value-based contracts.

The candidate selected for this position can work remotely within the continental United States.

Preferences: Value-based contracting, commercial pricing, Medicare pricing, reserving, medical economics, commercial, Medicaid or Medicare risk adjustment, or Financial forecasting and Analysis.


Responsibilities:

  • Determine the performance measures, associated benchmarks, and other contractual components to include in new-formed value-based contracts. Assures reliability of measures and statistical methodologies in tracking performance.
  • Provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Analyze Fee For Service arrangements, contract changes, and project future unit cost trends. Calculate values of network relativity factors used in rating and underwriting. Evaluate and model alternative payment models (e.g. per diem vs DRG, bundled payments, case rates).
  • Provide expertise to Contracting and Network services areas in rate modeling and fee schedule preparation, training, process development, etc.
  • Create and analyze ACO contracts, PCMH arrangements, Global Capitation, Bundled Rates, Episodic Payments, Capitation, Risk Adjusted Total Cost of Care, and Value Based Payments.  Review risk/shared savings payouts and accruals.
  • Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Stop Loss Insurance or Workers Compensation.
  • Work closely with Enterprise Risk Management and key internal stakeholders to build and enhance insurance (underwriting and reserving) risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers.
  • Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, including IBNR calculations and Data Analysis.
  • Ability to solve issues with a sense of urgency.
  • Performs in accordance with system-wide competencies/behaviors.
  • Performs other duties as assigned.

 

Qualifications

  • Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.
    • Advanced degree preferred.
  • Licensure/Certification:  ASA or FSA certification by Society of Actuaries required. Membership in the American Academy of Actuaries required.
  • 6.5 years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  • Experience with commercial and government health programs preferred.
  • In-depth understanding of health insurance market dynamics.
  • Excellent problem-solving and analytical skills.
  • Good oral and written communication skills.
  • Strong PC skills.
  • Data retrieval skills and relational database experience.
  • Management experience preferred.


Licensure, Certifications, and Clearances:
Licensure/Certification: ASA or FSA certification by Society of Actuaries required.Membership in the American Academy of Actuaries required.

4 or more preliminary exams and completed FAP modules while working towards credentialing or ASA/MAAA designation
 

  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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