Job Description

Job Title: Director, Clinical Operations
Job ID: 716809
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Medical Mgmt Admin
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC is hiring a full time Director, Clinical Operations to support UPMC Health Plan.  This will be a Monday through Friday daylight role based out of Pittsburgh, Pa.  We are looking for a proven leader that has robust clinical operations knowledge as well as strong communication abilities.


The Director, Clinical Operations will be expected to direct and manage the medical management activities of the Health Plan, for all products.

Responsibilities:

  • Acts as an interface with new client accounts to provide data and information on all clinical services such as Utilization Management, Disease Management, Care Management, Complaints and Grievances, Patient Centered Medical Home and Maternity and Pediatrics,
  • Acts in an advisory capacity to internal departments such as legal and financial with respect to any new relationships with outside entities from a clinical perspective.
  • Develop the operating budget for the functional area and manages resources appropriately.
  • Directs the establishment and maintenance of strong business relationships with internal consumers and external entities.
  • Directs the review, responses and facilitates Requests for Proposals (RFPs) from external entities.
  • Function as a liaison between the UPMC Health System and other network facilities as required.
  • Leads innovative medical/clinical programs through early ideation, development and early implementation.
  • Participate in the development of the departmental strategic business plan to ensure the attainment of the Health Plan's strategic objectives by identifying, recruiting, developing, directing, and evaluating personnel within the department.
  • Participates in research and educational activities that promote new knowledge development and action in the clinical field that promotes the effective transformation to a population health management model.
  • Participates in the development of new, value-based design products and strategies with employers and members to advance health outcomes.
  • Represent Medical Management on internal and external forums and committees, as requested.
  • Specify personnel accountability and evaluates performance regularly. Establish and delegate the job duties for all positions
  • Works with health plan leaders in clinical operations to improve the performance and utility of non-physician, clinical services impacting gaps in care closure, transition of care outcomes and longitudinal management of high risk members.

Qualifications

  • Bachelors Degree in health care field or related field (Masters Degree strongly preferred)
  • Minimum of seven to ten years of experience in managed care setting
  • Three years of management experience in managed care plans (experience in Pennsylvania strongly preferred).
  • Excellent verbal and written communication skills, analytical and organizational skills are required.
  • Extensive problem-solving experience is required.
  • Ability to multi-task, shifting back and forth effectively between two or more activities or sources of information.
  • Experience with product expansion efforts preferred.

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

Salary Range: $0 to $0

Union Position: No

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