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

Senior Medical Director, Medicaid

Description

The Senior Medical Director will have the rare and exciting opportunity to join a senior team recognized as UPMC's best and brightest leaders. They will shape the way UPMC Health Plan manages its Medicaid product, UPMC For You. As an integral part of the organization, it is paramount that this physician business executive exhibits leadership qualities and expertise that will raise UPMC Health Plan to new levels of excellence and execution. The success of UPMC Health Plan's Medicaid work will rely upon this individual's creativity, discipline, detail, and a passion to 'make a real difference' beyond conventional managed care. The selected candidate will create a standard for measurable clinical excellence by which competitors will be evaluated, resulting in the acquisition of profitable, long-term market share in the region.

Responsibilities:

  • Provide leadership for management of UPMC For You's clinical and medical affairs to include; leading, educating and mentoring the clinical team and providing product-specific guidance to Quality, utilization and care management, and population health.
  • Key member of UPMC For You leadership team, supporting clinical program development and offering clinical insights to utilization and cost trends. Helps to lead initiatives designed to enhance utilization and costs.
  • Provide clinical support for the Medicaid Quality Improvement program, including study design for NCQA accreditation initiatives, coordination of HEDIS reporting, as well as meeting or exceeding all regulatory requirements. Interface with UPMC Health System cross-functional and shared resources to create a seamless process for our members.
  • As a clinical 'thought leader' and UPMC Health Plan physician liaison, participate in the creation of opportunities to consult, interact and elicit feedback with the physician community. Support development of strategies built on this valuable information, enhancing proactive clinical interventions. Serve as an integral part in the design and implementation of medical management initiatives to improve quality and cost effectiveness of care delivered to Medicaid members.
  • Swiftly respond to challenges and/or opportunities as they arise. Develop and implement innovative programs to act on historical data, identifying new trends, retooling existing approaches, and analyzing the competition.
  • Identify opportunities to further integrate information systems and departmental interface capabilities, and from a clinical perspective, assist in affecting the 'phase-in' of newly acquired OAO interactive software.
  • Influence medical cost trend in partnership with network services and medical management team, including development of trend-specific initiatives, provider fee schedule review, and identification of medical management best practices. Create opportunities to integrate pharmaceutical and medical strategy with innovative solutions.
  • Assist with the development of a clinical organization that prioritizes the retrieval and intuitive interpretation and evaluation of statistics and medical trends in order to establish aggressive preventative health targets and objectives for Medicaid members.
  • As an integral member of UPMC Health Plan's leadership team, serve as a 'role model' and 'health advocate' within the Pennsylvania community, including active participation with UPMC-sponsored activities, public events and community outreach programs. Nurture personal and professional growth/development by attending seminars, workshops, and establishing professional affiliations to keep abreast of latest trends in field of expertise.

Qualifications

  • The Senior Medical Director will possess extensive experience in clinically leading Medical Affairs within a progressive Medicaid managed care organization, ideally having created and driven innovative clinical program initiatives as well as having initiated NCQA accreditation and certification.
  • Experience within a Medicaid health plan that has truly developed a relationship with the physician and patient community; genuinely collaborative in nature, value-added versus commodity-driven, cross-functionally efficient and consumer-driven.
  • Will possess a passion and commitment to help change the way healthcare is delivered, a track record of developing leading-edge Health Plan clinical strategies while motivating an organization to achieve 'stretch goals' to drive innovation, and do 'what is right today, rather than tomorrow.
  • Solicit support, evaluate, direct and hold one's self and employees accountable, while maintaining high morale and productivity during favorable and unfavorable conditions.
  • Expert managed care clinical leadership skills, leveraging a broad knowledge base in managed care.
  • Must possess a global understanding of the industry: legislative/regulatory developments, national product and delivery trends, maintenance of key industry relationships and tracking competitors.
  • Highly developed interpersonal and communication skills, both written and verbal, and an executive demeanor which interacts effectively with all organizational stakeholders regarding sensitive and/or complex topics.
  • Ability to plan and schedule multiple tasks/projects and to maintain control of one's own and others' work flow to achieve results ahead of schedule and within budget.
  • Highly developed analytical skills.
  • Operates effectively in a 'matrix' environment.
  • Views the various matrix partners within UPMC as customers.
  • Possesses the appropriate level of patience, and persistence, to move


Licensure, Certifications, and Clearances:

  • Pennsylvania MD or DO license required.
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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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