Job Description

Job Title: Senior Medical Director- Quality Improvement and Innovation
Job ID: 735403
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Improvement
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC is actively seeking a full time Senior Medical Director - Quality Improvement and Innovation! This will be a Monday- Friday daylight role located in Pittsburgh, Pa.

 

The Senior Medical Director will have the rare and exciting opportunity to join a senior team recognized as UPMC's best and brightest leaders. He/she will shape the way UPMC Health Plan delivers best quality and outcomes to all lines of business and significantly influence clinical and quality aspects of Medical Affairs. 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 will rely upon this individual's creativity, discipline, detail and a passion to 'make a real difference' beyond conventional managed care. by developing new quality and patient experience programs.


Responsibilities:

  • Serve as the medical director for the health plan Quality Department and quality liaison and advisor to all lines of business within the health plan and key collaborator and subject matter expert with any integrated delivery and finance system joint clinical quality initiatives.
  • Provide clinical leadership and support for health plan Quality Improvement programs, including NCQA accreditation initiatives, coordination of HEDIS reporting, CMS Stars, as well as meeting or exceeding all regulatory requirements.
  • Collaborate with the Chief Quality Officer and VP, Quality Improvement and Performance to engage all functional areas of the Health Plan from a quality perspective to develop innovative programs as well as products lines; serving as the primary quality liaison with Network Services, Strategic and Advisory Services, Finance and Underwriting, Operations, Information Systems, Pharmacy, and Product Development.
  • Interface with UPMC Health System cross-functional and shared resources to further the 'cause' to create a seamless healthcare patient-flow management process and insurance model.
  • As a 'thought leader' and UPMC Health Plan physician liaison, participate in the creation of opportunities to consult, interact and elicit feedback with the physician community, then act upon this valuable information, raising proactive clinical intervention to unprecedented levels.
  • Serve as an integral part in the design and implementation of medical management initiatives and leader of quality and outcomes strategy such as disease management to improve quality and cost effectiveness of care delivered to Commercial, Medicare and 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.
  • Collaborate with the Chief Quality Officer,Vice President, Quality Improvement and Performance, and Health Plan senior leadership in the development of short-term, mid-term, and long-range strategic planning for the Health Plan.
  • Partner with physician leaders, and hospital and business executives to exceed clinical, operating, financial, quality, and market share objectives.
  • Deliver executive level presentations for UPMC senior management and other designated groups.
  • Collaborate with physicians to develop clinical programming by accessing and mining quality and clinical data, devising methods to manage populations.
  • Partner with physicians to improve reimbursement model and performance based physician incentive programs.
  • Create progressive physician group and provider education programs; direct concurrent education and communication related to QI and best practices. 
  • As an integral member of UPMC Health Plan's leadership team, serve as a 'role model' and 'health advocate' within the Western 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

  • M. D. Degree is required, and a Masters Degree is preferred in healthcare, marketing, business administration, or other related fields of study.
  • The Senior Medical Director will possess extensive experience in clinically leading Medical Affairs within a progressive managed care organization, ideally having created and driven innovative clinical program initiatives as well as having initiated NCQA accreditation and certification. 
  • Experience within a 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. 
  • Ability to lead, motivate and mentor superior Medical Directors in pursuit of progressive programming.
  • Solicit support, evaluate, direct and hold ones 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 ones 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 issues forward while competing in a highly complex, turbulent, and market-driven industry. 
  • Exudes a leadership style emphasizing collaboration, teamwork, participation and communication. 
  • Willingness and ability to delegate responsibility to senior subordinates while allowing them room to identify ways and means to `take action and accomplish specific goals and objectives. 
  • Contributes imaginative and innovative ideas; encourages idea generation of others; open, accessible and communicative; sensible, fair and objective in decision-making; willing and able to confront difficult choices. 
  • Possesses unquestioned integrity; trusting of others and worthy of their trust; a consensus-builder in a transforming organization; highly accomplished in interpersonal diplomacy; active and energetic, a self-starter, well organized and efficient.

    Licensure, Certifications, and Clearances:
    Pennsylvania MD or DO license required

  • Doctor of Osteopathy or Medical Doctor


UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

 

Salary Range: $0 to $0

Union Position: No

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