At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

Job Description

Job Title: Director, Clinically Integrated Network (Population Health)
Job ID: 883364388
Status: Full-Time
Regular/Temporary: Management
Hours: Standard Business
Shift: Day Job
Facility: UPMC Pinnacle
Department: Managed Care Contracting
Location: 1426 N Third Street, Harrisburg PA 17102

Description

UPMC Pinnacle is searching for a Director, Clinically Integrated Network to join their team!  This position is located in Harrisburg, PA and travels locally throughout the week.

The Director, Clinically Integrated Network is responsible for the development and management of UPMC Pinnacle's Clinically Integrated Network (CIN) Concert, its market strategy and expansion, physician alignment and value based managed care contracts.  To learn more about Concert, visit this link: https://concerthealthalliance.org/

 

The Director leads all Clinically Integrated Network operations, development and expansion, risk alignment for programs including Commercial Managed Care, Medicare Advantage and Medicaid pay for value programs. They will lead the development of the network for the markets and successfully manage value based contracts with payors including UPMC Health Plan. Additionally, this position works collaboratively with the UPMC Pinnacle Medical Group, UPMC Population Health and UPMC Hospital leadership, quality, finance, IT and managed care staff.

The ideal candidate has prior healthcare, population health, and insurance experience.  Data analytics, quality improvement, and leadership skills are also desired.  If this sounds like a fit for you, apply online today!

Responsibilities:
  • Works collaboratively in cooperation with UPMC to ensure staff and employees effectively manage ongoing operations in line with driving excellence in operations and patient care.
  • Collaborates with UPMC in administrative support responsibilities including creating and managing annual operating budget, hiring and management of market/network staff and efficiency of centralized operating functions.
  • Meet with staff, employees, and independent practices on a frequent basis to effectively and timely disseminate information, gives staff opportunity for input on solving issues; improves communications, encourages effective teamwork and positive morale.
  • Accountable for the operations of Concert and the value based contractual agreements to ensure they relate to strategy, execution, adherence and maintenance of effective care center and network management.
  • Responsible for leading and managing the key day-to-day operational aspects of market/network development, management and value based arrangements.
  • Leads and directs multi-functional team including IT, clinical and analytics to develop network reporting tools to evaluate and develop actionable reports to communicate to providers regarding quality and cost efficiency opportunities.
  • Analyze program goals and objectives given current health care trends, makes accurate short- and long-term projections to establish program needs and resource requirements; and to help identify potential sources of funds and revenues to meet those requirements.
  • Ensures compliance with regulations and governing rules of UPMC and the Clinically Integrated Network and contracted payers.
  • Leads with vision and creates a culture that reflects a patient care-focused environment. Works collaboratively in cooperation with UPMC and independent practice staff to effectively resolve operational, staff and financial issues pertaining to the practice.
  • Drives initiatives that organizationally contribute to long-term operational excellence. Ensures the long term financial viability of the market/network in value based agreements.
  • Defines market/network needs and gaps in current capabilities. Assesses network adequacy to resolve the gaps for all provider types (acute, ambulatory and post-acute) and build networks necessary to offer to payers and employers cost efficient quality solutions for their populations.
  • Oversees physician partnerships creating a shared vision and fostering a relationship characterized by open communication, trust and the values of CINs and UPMC.
  • Accountable for partnering with Concert Board of Managers to establish networks and services necessary to successfully manage value based contracts. Support the Concert Committees in developing quality measurement and reporting, payer relations strategy, support negotiations as necessary, including issues pertaining to prioritization, on behalf of the CIN. Diretcs and organizes CINs Board of Managers and all organizational committee meetings.
  • Ensures care center management and Clinically Integrated Network provides appropriate data and analytics to allow providers to effectively evaluate all aspects of the CIN performance.
  • Responsible for driving change through a strong partner ship and collaboration in managing value based contract lives to achieve shared contractual costs and quality goals. Partnership will be with the leaders from independent physician groups, UPMC and payers.
  • Develops and motivates direct reports and key support areas to effectively deliver upon individual and CIN objectives in an efficient and innovative manner. Recognizes and rewards a high performing workforce, including recognition for excellence in patient care, teamwork and collaboration.
  • Develops effective working relationships with key stakeholders, leaders and staff.
  • Effectively leads staff and employees in a manner that engages and retains well-qualified staff.
  • Effectively engages staff and employees regarding the annual employee survey, including encouraging survey participation and developing an annual action plan based upon the results to drive continual improvement of the team's engagement. Demonstrates ownership and accountability of results and sets comprehensive team goals, which could include goals for personal improvement, and ensures goals are accomplished. Ensures staff is kept updated on progress and accomplishment of goals.
  • Responsible for the development of transformative risk management solutions drawing from national best practices, analytics, personal expertise and creativity to deliver value based solutions and ensure an innovative network of providers.
  • Develops and leads the strategy within the broad context of the system wide landscape by using performance measurements to guide strategic and operational decision-making.
  • Works collaboratively in cooperation with UPMC to ensure staff and employees effectively manage ongoing operations in line with driving excellence in operations and patient care.
  • Demonstrates an ability to translate strategy to operational tactics. Focuses efforts on actions that will have the greatest strategic impact. Strong operational knowledge about the functions and processes that contribute to operational performance. Educates management and staff on healthcare and business climate changes.

Qualifications

  • Bachelor's degree in business administration, health administration or other related field is required.  
  • Master's degree preferred.
  • At least 7+ years of experience in healthcare, care delivery, billing, insurance, reimbursement or related field.  
  • Managed Care Network, Provider Relations, Integrated Healthcare Delivery System, and/or clinical/nursing experience is a plus.
  • Candidate should also have relevant experience and demonstrated success in business development.
  • Experience with payer relations/contracting.
  • Experience managing multiple, large-scale, complex projects.
  • Strong skills developing and implementing operating plans and analyzing both financial and quality data.
  • In-depth knowledge of the healthcare industry.
  • Strong and effective oral and written communication skills.
  • Demonstrated ability to effectively manage provider relations.

Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days.

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

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $0 / hour

    Union Position: No

    Apply Current Employee?

    UPMC VALUES

    At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

    QUALITY & SAFETY
    DIGNITY & RESPECT
    CARING & LISTENING
    RESPONSIBILITY & INTEGRITY
    EXCELLENCE & INNOVATION

    UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


    WORKING HERE



    Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

    Learn more about working here and check out our policies and recent updates.

    UPMC Health Plan Named Best Places to Work for LGBTQ Equality in 2020


    UPMC Ranked #1 Best Places for Women and Diverse Managers in 2019

    Share:
    Talent Network