Description

Purpose:
This position is responsible for the development and management of UPMC Children's Hospital of Pittsburgh (CHP) Clinically Integrated Network (CIN)- the Pennsylvania Pediatric Health Network (PPHN). The Director Role is responsible for its market strategy and expansion, physician alignment and value-based managed care contracts. The Director will report to the PPHN President and the PPHN Board of Managers. The Director leads all Clinically Integrated Network operations, development and expansion, population health management, risk alignment for programs including Commercial Managed Care, Children's Health Insurance Program (CHIP) and Medicaid pay for value programs. The position will lead the development of the network for the CHP markets and successfully manage value-based contracts with payors including UPMC Health Plan. Additionally, this position works collaboratively with the UPMC Children's Executive Management group; UPMC Children's Community Pediatrics leadership; UPMC Population Health and UPMC Hospital Services Division leadership as well as Quality, Finance, IT and Care Management staff and counsel.

Responsibilities:

• *Performs other duties as assigned.
• *Performs in accordance with system-wide competencies/behaviors.
• Responsible for the development of transformative risk management solutions drawing from national best practices, analytics, personal expertise and creativity to deliver value-based solutions and ensure an innovative network of providers.
• Responsible for driving change through a strong partnership and collaboration in managing value- based contract lives to achieve shared contractual costs and quality goals. Partnerships include the leaders from independent physician groups, UPMC and payors, external/community partners and specialists.
• Oversees physician partnerships creating a shared vision and fostering a relationship characterized by open communication, trust and the values of CINs and UPMC.
• Ensures compliance with regulations and governing rules of UPMC and the Clinically Integrated Network and contracted payers.
• Drives initiatives that organizationally contribute to long-term operational excellence. Ensures the long term financial viability of the market/network in value based agreements.
• Develops and motivates direct reports and key support areas to effectively deliver upon individual and PPHN objectives in an efficient and innovative manner. Recognizes and rewards a high performing workforce, including recognition for excellence in patient care, teamwork, and collaboration.
• Demonstrates an ability to translate strategy to operational tactics. Focuses efforts on actions that will have the greatest strategic impact. Strong operational knowledge about the functions and processes that contribute to operational performance. Educates management and staff on healthcare and business climate changes.
• Defines market/network needs and gaps in current capabilities. Assesses network adequacy to resolve the gaps for all provider types (acute, ambulatory, and post-acute) and build networks necessary to offer to payers and employers cost efficient quality solutions for their populations.
• Collaborates with UPMC in administrative support responsibilities including creating and managing annual operating budget, hiring and management of market/network staff and efficiency of centralized operating functions.
• Analyze program goals and objectives given current health care trends, makes accurate short- and long-term projections to establish program needs and resource requirements; and to help identify potential sources of funds and revenues to meet those requirements.
• Leads with vision and creates a culture that reflects a patient care-focused environment. Works collaboratively in cooperation with UPMC and independent practice staff to effectively resolve operational, staff and financial issues pertaining to the practice.
• Leads and directs multi-functional team including IT, clinical and analytics to develop network reporting tools to evaluate and develop actionable reports to communicate to providers regarding quality and cost efficiency opportunities.
• Ensures PPHN Clinically Integrated Network Analytics Operation provides appropriate data and analytics to allow providers to effectively evaluate all aspects of the PPHN performance.
• Accountable for partnering with PPHN Board of Managers to establish networks and services necessary to successfully manage value-based contracts. Support the PPHN Committees in developing quality measurement and reporting, payer relations strategy, support negotiations as necessary, including issues pertaining to prioritization, on behalf of the PPHN. Directs and organizes PPHN Board of Managers and all organizational committee meetings.
• Responsible for leading and managing the key day-to-day operational aspects of market/network development, management and value-based arrangements.
• Works collaboratively in cooperation with UPMC to ensure staff and employees effectively manage ongoing operations in line with driving excellence in operations and patient care.
• Accountable for the operations of the PPHN and the value-based contractual agreements to ensure they relate to strategy, execution, adherence and maintenance of effective care center and network management.

Qualifications

Qualifications:

• Bachelor's degree in business administration, health administration or other related field (e.g. nursing).
• Master's degree preferred.
• At least 7+ years of experience in healthcare, care delivery, quality/safety, healthcare finance or related field.
• Managed Care Network, Provider Relations, Integrated Healthcare Delivery System, and/or clinical/nursing experience is a plus.
• Preferred candidates should also have relevant experience and demonstrated success in business development, including experience with payer relations/contracting.
• Experience managing multiple, large-scale, complex projects.
• Strong skills developing and implementing operating plans and analyzing both financial and quality data.
• In-depth knowledge of the healthcare industry.
• Strong and effective oral and written communication skills.
• Demonstrated ability to effectively manage provider relations.

Licensure, Certifications, and Clearances:

• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal


• UPMC is an Equal Opportunity Employer/Disability/Veteran

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