Description

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 Sr. Director, CHC Operations, the Coordinator, will manage the directions of activities related to operation of UPMC Community Health Choices (CHC) membership including long-term services and supports. Provides day to day operational oversight related to product implementation and fulfillment of contract obligations. Will manage relationships across department to assure service coordination between Medicare and Medicaid as it relates to CHC.

Responsibilities:

• Continuously evaluate and document customer needs and all aspects of business processes. Ensure that all required steps necessary to meet governmental and internal/external standards and regulations are met.
• Acts as a point of escalation for all implementation and operational issues. Identify areas of potential compliance risk and develop solutions for risk mitigation.
• Perform statistical analyses, and then be able to explain this analysis to a non-technical audience of both internal and external customers and, at times, senior management.
• Develop and maintain working relationships with internal Health Plan departments, and external contacts as appropriate. Maintain policies and procedures of the team / department.
• Oversee and provide guidance to peers and serve as reference point for questions on day-to-day basis. Prepare and distribute work assignments.
• Work with Sr. management to achieve efficiencies across integration of products.Represent CHC Operations on internal and external forums and committees as requested.
• Perform peer reviews as requested. Coordinate the orientation of new staff members.
• Develop and manage compliance and operational reporting matrix that continuously monitors CHC Performance. Participate in all phases of the recruitment and performance management process, as needed.
• Responsible for managing, leading, and developing the team of implementation staff to ensure seamless operation and successful implementation of CHC across zones.
• Work in close collaboration with Medicare, Medicaid, and D-SNP product teams. Work in close collaboration with clinical leadership and teams responsible for CHC.
• Analyze and trend data to identify inefficiencies and implement process improvement. Lead multidisciplinary workgroups to plan, strategize, identify problems and implement solutions.
• Manages and directs staff, supporting professional growth by providing education, training and appropriate resources. Assist in the development/refinement of policies and procedures
• Identify trends in expenses, utilization, medical quality, and other areas. Investigate variances and derive solutions to cost increases and quality issues.
• Implement and monitor effectiveness of these solutions. Perform cost/benefit analysis. Meet deadlines and turnaround times set by managers and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).
• Report staff productivity on a weekly, monthly and quarterly basis. Identify departmental needs and reports to management as appropriate.

Qualifications

B.S. degree in Education, Business or other related field or equivalent work experience will be considered. Minimum of 5 years' experience in financial and/or medical analysisExperience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered. Superior computer skills are a given, with proficient knowledge in Microsoft Office products.Prior experience leading/ supervising staff essential. Demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis. Ability to work in a fast-paced environment a must. Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences. Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity. Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities.

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