Job Description

Job Title: Director, Government Product Operations
Job ID: 729407
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Community HealthChoices
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC is actively seeking a full time Director, Government Product Operations for our Community HealthChoices team. This role will be for Pittsburgh, PA. 

Community HealthChoices (CHC) is Pennsylvania's managed care long term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid. 

Under the general direction of the Vice President, the Director, Gov't Product Operations directs the development, implementation, and ongoing administration of the UPMC Health Plan to support overall growth, member satisfaction, and regulatory compliance goals. 

The Director works with a broad spectrum of UPMC Health Plan personnel and physician leaders to contribute to the development of the overall strategy of the Health Plan's government programs. The Director also identifies, plans, develops, and implements strategy for operational management and development so as to meet organizational performance plans within agreed upon budgets and time scales. The Director is responsible for establishing and maintaining appropriate systems for measuring and monitoring regulatory standards, operational management, and development of the UPMC for Life programs necessary to compliantly meet the all program requirements. The Director functions as a liaison between all of the Health Plan business units and acts as a contact with the CMS and related governmental agencies.

Responsibilities:
  • Collaborate with the UPMC Health Plan Marketing and Health Plan Communications departments to design effective, compliant, and timely marketing and member communications campaigns.
  • Contribute to the evaluation and development of operational strategy and performance in cooperation with the executive team.
  • Direct and support government product operations to achieve target MER.
  • Direct, manage, and develop direct reporting staff. Control departmental expenditure within agreed budget.
  • Ensure activities meet with and integrate with government programs and organizational requirements for quality management, legal stipulations, and regulatory affairs.
  • Establish and maintain appropriate systems for measuring necessary aspects of program performance, and monitor operational performance of all supporting systems, including call center, member services, enrollment, revenue management, and reporting..
  • Identify, plan, develop, and direct the implementation of government products business plans to achieve organization goals while supporting the overall compliance strategy
  • Liaise and meet regularly with functional/departmental directors of the Health Plan to assess all necessary aspects and needs of the operational development of the government programs and to ensure full comprehension of objectives, purposes, and financial goals while adhering to compliance and regulatory standards.
  • Manage effective communications and working relationship with CMS, including coordination and management of mandatory reporting and regulatory activities.
  • Manages the annual benefit implementation processes, supporting growth and member retention goals.
  • Monitor, measure, and report on operational issues, opportunities, development plans, and achievements within agreed formats and timescales.

Qualifications

  • Bachelors degree in business, health care or financial studies or related field required. 
  • 7 years of experience in managed care setting primarily related to Medicare programs required. 
  • Excellent verbal and written communication skills. 
  • Analytical and organizational skills are required. 
  • Extensive problem-solving experience is required. 
  • Experience in development, implementation, and ongoing management of Medicare Advantage programs is essential. 
  • Excellent managerial, analytical, organizational, and customer service skills are key. 
  • The ability to continuously interact effectively with all levels of management is critical. 
  • Must possess ability to develop and analyze business processes to develop operational processes.

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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