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Job Description

Job Title: Senior Manager, Government Product Operations- Medicaid
Job ID: 19504163
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: 68740 HPLAN Medicaid Programs
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a full-time Senior Manager, Government Products to help support the Medicaid Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.


The Senior Manager will be responsible for the operational oversight of all Medicaid products including the enrollment data and the performance. The Senior Manager is expected to operate the business and financial operations related to Medicaid product line. The role will pull data and provide best practices benchmarks and standards to measure Health Plan operating performance are achieved.

Responsibilities:

  • Treat all staff and fellow UPMC employees with dignity, courtesy and respect in accordance with UPMC policy Staff and ad hoc reports as appropriate.
  • Maintain fee table implementation; perform physician and hospital reimbursement analysis.
  • Work collaboratively with direct reports as well as with staff that is dedicated to the Medicaid program from other departments to ensure effective program integration
  • Manage the department of dedicated Medicaid Operations to perform to following essential functions: Business and financial operations related to the Medicaid product line includingthe enrollment activity for the Medicaid and PCO productAnalysis of the impact of network development Manage benefits Reimbursement oversight and management Manage and oversee all Encounter Data activity for the Medicaid and PCO product Monitor Health Plan operating performance against best practices benchmarks and standards and against financial projections
  • Create and maintain a complete file in/file out process to handle all DPW data files in a systematic process.
  • Ensure timely communication and training of key department personnel impacted by new or changed products/programs and benefit packages
  • Develop strategic and tactical business plans for company departments to achieve corporate business objectives and achieve operational compliance
  • Effectively managed and responsible for COB/TPL process.
  • Identify and work with Fraud and Abuse department to establish benchmarks for fraud and abuse related transactions
  • Maintain an ongoing working relationship with key DPW and other contacts

 

Qualifications

  • Bachelor Degree from an accredited college or university, MBA is a plus
  • Six or more years' experience in medical assistance or government programs
  • 3 years of Healthcare and operations-related training is preferred. 
  • Product development experience, specifically in government product lines in the health insurance industry
  • Regulatory and product filing experience
  • Previous Management experience preferred
  • Manage staff of ten employees or more.
  • Extensive Medicaid product knowledge
  • The candidate must have excellent computer skills with emphasis on Microsoft Excel, Word, Access and other financial software packages.
  • His/her experience must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis as well as managing multiple tasks.
  • The successful candidate will have demonstrated competency in attention to detail, organizational skills as well as interpersonal and political savvy, strong communications, team and customer orientation, and ability to deal with ambiguity.


    Licensure, Certifications, and Clearances:

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

 

Salary Range: $34.96 to $59.20 / hour

Union Position: No

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