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   Current UPMC employees must apply in HR Direct

Chief Quality Officer, VP Quality Performance

Description

UPMC is a $21 billion health care provider and the largest nongovernmental employer in Pennsylvania, integrating 90,000 employees, 40 hospitals, and 700 doctors’ offices and outpatient sites. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial, and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International.

 

The UPMC Insurance Services Division—which includes UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health—offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to more than 3.9 million members.

 

The Chief Quality Officer and Vice President of Quality Improvement and Performance will be responsible for leading the quality of care and best practice guidelines, ethical standards and protocols, and clinical outcomes for all UPMC Health Plan lines of business. This key leader will provide strategic perspective and over-arching direction for Quality Performance programs and will assure that programs meet or exceed all external regulatory requirements. Additionally, this position will continue the turnkey drive for impeccable quality vision, will mandate excellence in quality goals and recommend critical organizational changes to achieve those goals. Additionally, this CQO and VP will collaborate with shared services, such as clinical network services and quality improvement to achieve clinical, utilization management and other goals.

 
Responsibilities
  • Lead a 3.9 million-member health plan’s quality operations and strategies for new clinical care models, population health, alternative payment programs and regulatory compliance.
  • Lead the development of strategy and methodology for performance-based quality, cost of care, and member experience (satisfaction) in supporting physician and provider payment reform.
  • Develop direction and implementation of major system-wide clinical quality initiatives. Serve as an internal champion for quality measurement and improvement within the company and the outward-facing advocate for quality among external stakeholders (e.g. providers, professional organizations, employers and members, producers, and regulators).
  • Ensure the continual maintenance and documentation in accordance with NCQA, Department of Health, CMS and DPW standards for managed care organizations and oversee accreditation processes as they relate to Quality Improvement and Credentialing.
  • Direct the utilization of data and application of best practices and benchmarks to analyze provider performance and provide tools and strategies to facilitate network quality improvement.
  • Oversee the use of relevant data, producing reliable and valid information when analyzing service performance for network providers.
  • Direct accountability to the Board of Directors for Quality Performance
  • Deploy a variety of quantitative and qualitative methods to conduct program evaluation – pre-post analysis of clinical/financial outcomes; financial modeling; and, as necessary, more advanced statistical methods.
  • Actively solicit physician leadership, input, review and recommendations as it relates to quality management and improvement activities; present feedback to the Quality Improvement Committee and assure follow-up and implementation of action plans.
  • Strategize (in collaboration with Health Management and other Health Plan staff) innovative methods/approaches to process improvement in the areas identified as high cost, high risk or high volume for the plan's entire scope of business.
  • Oversee the strategic direction and framework for the valid collection of HEDIS ensuring the process, data and results are reviewed and analyzed to generate quality improvement initiatives for the network. Develop an enterprise annual HEDIS strategic plan in cooperation with product leads to ensure best practice HEDIS scores for all Health Plan lines of business. Where appropriate, use HEDIS measures as a foundation to ensure effective operation and consistency in health improvement activities of providers.
  • Oversee timely and accurate coordination of the complaint, grievance, and appeal processes to meet NCQA, DOH, CMS, and DPW requirements. Perform interim audits to identify potential disconnects in the processes and direct implementation of effective process changes as opportunities identified.
  • Ensure the multidisciplinary approach to reviewing HCAHPS and ECHO member satisfaction survey scores. Direct the analysis, identification of barriers, and development of effective interventions to improve performance. Review and monitor results and make necessary adjustments to assist in problem identification and resolution.
  • Experience with management and submissions of academic publications.
  • Represent UPMC Insurance Services Division at national conferences, professional groups, and other applicable organizations.
  • Keep abreast and knowledgeable of industry trends, technological and system changes, etc. with follow up communication and recommendations. 

Qualifications

  • Doctor of Medicine/Doctor of Osteopathy strongly preferred.
  • Minimum of seven years of quality management experience senior leadership oversight/experience in a managed care environment; 10+ years of experience highly desirable.
  • Industry knowledge of both Pennsylvania state and federal regulations surrounding quality.
  • Experience with health insurance plans and with NCQA accreditation for managed care organizations.
  • Demonstrated knowledge and experience with clinical quality management and improvement concepts, techniques, processes, and outcome measures.
  • Preferred experience in an academic medical center environment.
  • Comprehensive understanding of HEDIS and HCAHPS specifications and methodology.
  • Knowledge of and/or experience with regulatory requirements for the delivery of health plan products, including HMO, POS, FFS, Medicare and Medicaid models.
  • Well-developed analytical and problem-solving skills with the ability to understand, interpret, manipulate, and evaluate clinical and statistical data.
  • Exposure to health analytics and knowledge of comparative databases such as MedisGroups, HC4, and others highly desired.
  • Ability to successfully navigate a highly complex and matrixed organizational structure.
  • Demonstrated leadership capabilities, including staff development, mentoring, and coaching.
  • Excellent communication (verbal and written) presentation and platform skills. 


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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