Job Description

Job Title: Senior Manager- Gov't Programs Rev Max
Job ID: 681330
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: MEDICARE HCC
Location: 600 Grant St, Pittsburgh PA 15219


UPMC Health Plan is seeking a Senior Manager for their Risk Adjustment Department!


The Senior Manager is responsible for providing risk revenue financial services, strategic proposals and strategic programs in support of the Medicare Advantage and Specialty Needs product programs. Position incumbent will oversee the implementation, calculation, performance and analysis of the revenue generations processes for government risk based revenue products. The incumbent member and product risk revenue profiles levels are accurate and risk revenue targets are achieved to ensure UPMC Health plans government revenue retention and growth.


The incumbent will develop and oversee processes for the submission, management and reconciliation of government required data for the development, support and validation. The incumbent will have accountability to mitigate risk associated with inaccurate coding and risk scores which could result in lost revenue. The incumbent will have accountability for or support the development, management and validation of various provider engagement and management strategies to support improving the populations risk scores, including provider incentives, quality care management and Stars program goal as well as various provider risk share and gain sharing programs. The program is designed to assess exposures to RADV risk programs and effectiveness of divisional controls to mitigate those exposures.


Position incumbent will assist Gov't Programs Management with day-to-day oversight responsibilities of providing responsive and timely financial reporting and data analytics for various internal departments including both senior management and Medicare departments. Risk Management team members are lead contributors in all aspects of the products risk management process and internal HealthPlan fraud program, to include


Coding experience is a strong preference.


  • Advanced excel, sass and access pc, database management and advanced financial analysis tools knowledge are also essential.
  • Analyze coding utilization to determine trends and provide key information to necessary management.
  • Assist with ensuring all stakeholders are kept in all communications regarding decisions on strategic initiatives
  • Collaborate with actuarial department to create and maintain financial models using financial assumptions based on detailed analytics and pro-forma revenue development.
  • Creative thinker and problem solver; ability to come up with new ideas and messaging concepts that meet current and future business objectives.
  • Direct staff in the preparation of studies, monthly statistical, revenue and forecasting analyses, reports and recommendations on budgets and financial planning.
  • Evaluate and provide revenue accruals for executive management and provide analyses and recommendations as necessary.
  • Excellent oral, written, presentation, and negotiation skills as well as advanced analytical and conceptual skills are required
  • Experience managing a divers professional staff is also required
  • Manage and own other special projects as assigned.
  • Manage third-party vendors or consultants hired to perform finance and analytical related functions.
  • Must be able to take charge of and be accountable for management of staff working on multiple projects to ensure product deadlines and objectives are met.
  • Oversee daily financial and analytical reporting to maximize Gov't Programs revenue.
  • Participate in Federal Government Agency committee and subcommittee meetings and local and/or regional conferences involving existing and future financial and analytical revenue requirements.
  • Partner with clinical staff in analyzing utilization and medical trends to forecast patterns of behavior in order to understand and maximize coding efforts in relationship to HCC methodologies.
  • Prepare weekly status reports to senior management relative to outstanding finance and analytical projects, ongoing monitoring and completed assignments.
  • Serve as principal Health Plan expert and go-to person on financial reporting and data analytics.
  • The ability to manage numerous projects and successfully manage projects with internal areas and external clients is required.
  • The incumbent must have a strong background in data management and analysis, project management, ability to perform advanced feasibility and cost/benefit analysis as well as design programs and oversee/manage staff.
  • The individual must also have a thorough knowledge of the business with excellent financial skills to produce sound financial projections in order to assist in the development of the HCC program campaign.
  • The individual should have advanced knowledge of UPMC Health Plans products as well as thorough knowledge and understanding of health care, insurance, general hcc planning.


  • Bachelors Degree in business finance, statistics, mathematics, health care management or closely related discipline is required but relevant Masters Degree is strongly preferred.
  • Eight (8) years experience in Healthcare
  • Five (5) years financial analysis.
  • Proven experience/knowledge of financial analysis reporting.
  • Verifiable experience with Medicaid and/or Medicare managed care is preferred. Excellent organizational and leadership capabilities with previous staff supervision.
  • Ability to continuously interact effectively and professionally with all levels of Health Plan staff.
  • Excellent written and verbal communication skills.
  • Ability to handle multiple priorities/projects in a fast-paced professional environment.
  • Working knowledge of word-processing and database software.
  • Demonstrated performance in meeting deadlines, particularly in matrix environments.

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $38.33 to $66.19

Union Position: No

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