Job Description

Job Title: Senior Medical Director- Pediatrics
Job ID: 769655
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Medical Director Service
Location: 600 Grant St, Pittsburgh PA 15219

Description

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 manages all services for children. 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. The Senior Medical Director will serve as a pivotal strategic and clinical leader, responsible for the medical role in products for all children, including those in CHIP, Medicaid and commercial, and will serve as the Senior Medical Director of our CHIP plan. . He/she will possess wide-ranging expertise in chronic care, disease management, utilization management and government programs. Serving as a bridge builder and champion, the Senior Medical Director will have a dual focus: leading a clinical team of nurses and clinicians, and leading cutting-edge population health management, quality initiatives (HEDIS, NCQA), health analytics initiatives, and ultimately will work to impact the health of pediatric populations.

Responsibilities:

  • Passionately manage children’s services in UPMC Health Plan's CHIP, and Medicaid lines of business, to include; leading, educating and mentoring, managing all strategic and clinical of Medical Management, Quality, Health Management, Utilization Management, Disease Management, Strategic Planning and Policy.
  • Provide clinical leadership and support for Quality Improvement program, including study design for NCQA accreditation initiatives, coordination of HEDIS reporting, as well as meeting or exceeding all regulatory requirements. Serve as Clinical Leader for the UPMC pediatric programs.
  • Collaborate with other relevant physician staff to engage all functional areas of the Health Plan from a clinical perspective to develop innovative programs.
  • 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 clinical 'thought leader' and member of the Medical Director community will 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 such as disease management to improve quality and cost effectiveness of care delivered to Commercial, CHIP 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 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 clinical data, devising methods to manage populations.
  • Partner with physicians to improve reimbursement model and performance based physician incentive programs.
  • Influence medical cost trend in partnership with network services and medical management team, including development of trend- specific initiatives, provider fee schedule review, and identification of medical management best practices.
  • Create opportunities to integrate pharmaceutical and medical strategy with innovative solutions.
  • Assist with the development of a clinical organization which prioritizes the retrieval and intuitive interpretation and evaluation of statistics and medical trends in order to establish aggressive preventative health targets and objectives.
  • Ensure continuous improvement strategies are established and implemented for Health Management outcomes and processes encouraging a culture which initiates intensive and persistent case management for members.
  • Serve on physician committees and work with each Health Management program to monitor, assess and ensure the program's clinical success.
  • Establish best practices for care programs including Diabetes, Asthma, Pediatric, and Maternity Programs.
  • 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

  • Minimum 10 years clinical experience. 
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school. 
  • Unrestricted License in Pennsylvania.
  • Post residency clinical experience. 
  • It is preferred that the Senior Medical Director will possess extensive experience with products within a progressive managed care organization, ideally having created and driven innovative clinical program initiatives as well as having initiated quality accreditation and certification.
  • Experience in Behavioral Health treatment and program development. 
  • At least 5 years of management experience preferred. 
  • Experience in managed care setting preferred. 
  • Ability to implement medical policies, and to enforce those policies through appropriate action. 
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care. 
  • Ability to implement programs of quality care analysis, peer review, and professional education.

  • 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.

    Licensure, Certifications, and Clearances:

  • Board Certification in Psychiatry required

  • Act 33 Child Clearance with Renewal

  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Doctor of Osteopathy or Medical Doctor

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

 

Salary Range: $0 / hour

Union Position: No

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