Job Description

Job Title: Director, Statutory Reporting - CHC
Job ID: 180001N8
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: CHC Revenue Rec
Location: 600 Grant St, Pittsburgh PA 15219

Description

Community HealthChoices will impact more than 400,000 people statewide who are dually eligible for Medicare and Medicaid or receive Medicaid funded long-term services and supports (LTSS). Through Community HealthChoices (CHC), we will coordinate physical health care and LTSS to enhance the quality of life and independence for frail seniors and adults with disabilities in home and community based environments as well as in institutional settings.

 

The Director, Statutory Reporting - CHC will assist the Senior Director and Vice President of Medicaid Programs and Individual and Small Group On/Off Exchange with day-to-day oversight responsibilities of providing responsive and timely reporting, data analysis and operations support to guide the overall strategic direction of the Medicaid and Individual and Small Group On/Off Exchange products.

 

  • Develop, monitor and oversee product performance, including reporting that integrates government product data as necessary
  • Oversee all budget and financial/analytical reporting for the Medicaid line of business.

  • Work with CFO, Medicaid Programs and Individual and Small Group On/Off Exchange, and key leadership in other functional areas of the Health Plan (such as Network, Pharmacy, Provider Services, Member Services, Medical Management, etc.), analytical, and operational staff to analyze and identify key opportunities improving current business practices and determining ways to expand business platforms. 

  • Partner with clinical leadership and management in analyzing utilization and medical trends to forecast budget and utilization patterns in order to maximize clinical and operational intervention opportunities.

  • Be the principal Health Plan expert and go-to person on Medicaid budget reporting and data analysis. Direct staff in the preparation of revenue and expenditure forecasting/statistical analysis, and other analysis and work to ensure all staff can provide key business recommendations based on the outcomes of their analysis. 

  • Provide key information to senior management in a timely and comprehensive manner.

  • Thoroughly develop, manage, maintain and monitor key business practices put in place to optimize revenue opportunities. 

  • Conduct business in a professional manner with potential vendor relationships in this regard, and establish all budget expectations for this area with the Senior Director of Medicaid Programs and Individual and Small Group On/Off Exchange and other product leadership 

  • Develop strategic predictive modeling methods to better understand the various Medicaid sub-populations and efficient ways to manage and monitor their utilization habits. 

  • Collaborate with management, analytical, operational staff and other key internal stakeholders to develop timely action plans to achieve developed strategic goals. 

  • Develop regulatory knowledge to work directly with Medicaid and On/Off Exchange Operations leadership to meet regulatory financial reporting requirements, develop IT solutions, and dashboards for monitoring compliance and business objectives.

  • Inform and advise management of government products of current trends, issues, problems and activities in functional areas, and develops and implements appropriate interventions to facilitate problem resolution and policy making in conjunction with changes resulting from corporate and ISD direction, as well as Healthcare Reform. 

  • Monitor operating performance against regional, national and international benchmarks.

  • Work closely and coordinate departmental priorities with Medicaid and Individual and

  • Small Group On/Off Exchange management staff.

  • Mentor and develop the department's analysts; develop skills and career goals.

 

Qualifications

  • Bachelor's Degree in accounting, business finance, statistics, mathematics, health care management or closely related discipline is required but relevant Master's Degree is strongly preferred.

  • Healthcare and financial certifications and operations-related training is preferred.

  • 8 years of proven experience/knowledge of financial analysis, statutory reporting and program management is required.

  • 8 years experience with Medicaid and/or Medicare managed care is preferred.

  • Excellent organizational and leadership capabilities with previous staff supervision experience.

  • Ability to continuously interact effectively and professionally with all levels of Health Plan staff.

  • Excellent written and verbal communication skills, including strong abilities to communicate complex data concisely to many different audiences.

  • Exceptional analytical and problem solving skills

  • Ability to handle multiple priorities/projects in a fast-paced professional environment.

  • Proficient with all Microsoft Office products; working knowledge of word-processing and database software (SQL or SAS programming preferred)

  • Demonstrated performance in meeting deadlines, particularly in matrixed environments.

Licensure, Certifications, and Clearances: N/A



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


Salary Range: $0 / hour

Union Position: No

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