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

Manager, Provider Data & Contracts (Remote)

  • Job ID: 615074184
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Network Management
  • Location: 339 Sixth Avenue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $33.86 to $57.80 / hour

Description

UPMC and Community Care Behavioral Health (CCBH) have an exciting opportunity for a Manager of Provider Data and Contracts. This is a fully remote Monday through Friday, daylight role (regular, full-time). 

Under the general direction of the Senior Director of Reimbursement, the Manager of Provider Data and Contracts is responsible for and accountable to plan, lead, assign, supervise and control activities related to the management of the provider data repository and contracts. This includes oversight and management of a contract management system as well as implementing strategic plans to improve the maintenance of provider data. The Manager of Provider Data and Contracts will manage a team of contract and business analysts.

Responsibilities:

  • Manage all contract amendment projects and the resulting updates to Cactus
  • Oversee and contribute to the development and maintenance of SQL Server Reports
  • Oversee quarterly Sarbanes-Oxley audit of provider contracts
  • Oversee the provider network participation process to ensure compliance with credentialing and contracting standards
  • Assign work load/projects to staff members as appropriate, very accuracy and address concerns when necessary.
  • Perform analysis of provider claims and explain results to Medical Director of Med Management
  • Manage all areas of provider data maintenance including Provider Network Inquiries service account, Provider Web-based tools, Delegate data files
  • Manage the Provider Termination Process including ongoing maintenance and enhancements
  • Regularly meet with the Credentials Manager of the Quality Improvement Department to resolve provider issues.
  • Manage and protect the integrity of the provider contracts and the contract management system
  • Develop and maintain workflow processes within the contract management system.
  • Review Precluded Provider Reports, identify any network providers and take appropriate action
  • Prepare staff evaluations and provide mentorship and training to aid in staff development
  • Define and drive consistent quality contract processes and practices
  • Participate in the definition, testing and implementation of ongoing Cactus enhancements
  • Manage a staff of Contract Specialists and Business Analysts
  • Provide reports on provider network requests, denials and trends
  • Maintain Provider Data Maintenance Sharepoint Site
  • Responsible for the execution of provider contracts and amendments
  • Conduct audits and analyze results on a routine basis for NCQA recognition reports, quarterly term report for Quality and the Department of Public Welfare, web directory audit for DPW and others as requested by the Department of Public Welfare, Fraud & Abuse and Internal Audit.
  • Request and interpret Geo Access reports for Provider Exception Requests to the Credentialing Committee
  • Ensure all provider documents are scanned accurately in Filenet P8
  • Ensure that all Policies & Procedures as well as related process flows are in compliance
  • Oversee working relationships with the Configuration, Credentialing and Ancillary Dental/Vision teams

Qualifications

  • Bachelor's degree in Business, Health Care or Financial studies, or related field with minimum of 5 years experience in health care insurance or health care delivery.
  • Master's degree in Business, Health Care or Financial studies preferred.
  • Experience with contracting strongly preferred. 
  • Management of provider data and contracts highly desirable.
  • Strong computer skills.
  • Excellent planning, documentation, organizational and analytical skills are required.
  • Leadership and project management skills also required.
  • Ability to interact and develop process flows between departments to positively impact the provider network.

Licensure, Certifications, and Clearances:

  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

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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