Job Description

Job Title: Director, Health Management
Job ID: 53655961
Status: Full-Time
Regular/Temporary: Regular
Hours: Monday thru Friday 9-5
Shift: Day Job
Facility: UPMC St. Margaret
Department: Care Management
Location: 815 Freeport Road, Pittsburgh PA 15215

Description

UPMC St. Margaret is a 250-bed, Magnet designated teaching hospital situated on a 21-acre campus near Aspinwall. It begins its second century of service with renewed dedication to more than 250,000 residents of northeastern Allegheny County and the Alle-Kiski Valley, providing residents convenient access to the area’s finest physicians and health services.  At UPMC St. Margaret, our primary care and specialty physicians, and clinical and support staff members, work together to provide patients with quality care and the latest technical and medical advances. 

As Director, you will be responsible for the development, implementation, and management of an integrated care coordination and health management system that facilitates the promotion, monitoring and continuous improvement of quality of care, quality of service, health care outcomes, patient/family satisfaction and utilization management across the continuum of care, particularly as part of managed care objectives, initiatives and contracts.

Responsibilities:
  • Develop methods for clinical and financial analysis to measure, monitor and evaluate systems, practice pattern, utilization management and care coordination against established goals, standards or benchmarks in areas of cost, qualify of care, qualify of service, outcomes, measures, and patient satisfaction.
  • In conjunction with Medical Director and Education Department, develop and implement educational programs related to care coordination and health management for physicians, care providers, and hospital employees.
  • Serve as a liaison and resource to promote understanding, integration and implementation of care coordination and health management across the hospital, and with clients and key partnerships and networks.
  • Implement and maintain a quality assurance program for the health management programs including collaboration with quality assurance and improvement and risk management.
  • Direct development, implementation, monitoring and improvement of clinical pathways, clinical guidelines, utilization review, and outcome measures and related education systems.
  • Direct the health management program and works with the Medical Director in program planning, goal setting and policy development to support hospital and network mission and strategic plans, particularly managed care contracts and initiatives.
  • Coordinate the development and implementation of administrative policies, procedures, and systems related to health management.
  • Maintain fiscal accountability for areas of responsibility.
  • Supports Medical Director and Clinical Medical Consultants in analysis, development, implementation and evaluation of outcomes and systems improvements across the care continuum.
  • Manage assigned personnel including recruitment, development and evaluation of practice and performance
  • Design tools and systems to facilitate and optimize the care coordination and health management processes across the continuum of care.
  • Responsible for following the mandatory reporting procedures for any incident or serious event that did affect or potentially could have affected the clinical care of any patient
  • Monitor compliance of care coordination and health management practices with internal and external regulatory requirements, laws, policies and procedures, and contracts.
  • Work with directors and managers in hospital and ambulatory care settings to facilitate the operations of care coordination and health management program.

Qualifications

  • Knowledge of clinical theory or business management normally acquired through a Master's degree in management or health related field. 
  • Knowledge of clinical practice and personnel management normally gained through a minimum of five years of progressively responsible experience including supervision. 
  • Broad knowledge of health care provider and payment system including understanding of hospital and ambulatory operations, disease management and insurance experience. 
  • Interpersonal skills necessary to effectively interact with medical staff, directors, managers, patient care providers, representatives of external agencies, and patients in hospital and ambulatory care settings. 
  • Oral and written communication skills necessary to effectively communicate goals and objectives, resolve interdepartmental and interpersonal issues, and compose reports. 
  • Effective presentation skills required. 
  • Analytical ability necessary to identify appropriate solutions to complex issues and to evaluate data with regards to resources, operations, care and utilization management.

Licensure, Certifications, and Clearances:
  • Clinical Social Worker (CSW) OR Licensed Social Worker (LSW) OR         Registered Nurse (RN)

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $0 / hour

    Union Position: No

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