At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds. Visit upmc.com/vaccinesupport to learn more about how you can help.

Our recruiters will continue to fill positions throughout this time, but 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.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Manager, Government Product Analytics

  • Job ID: 057987485
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8am-5pm
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Community HealthChoices
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

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.

 

 

The Manager of Government Product Analytics will assist the Senior Manager and/or Director with day-to-day oversight responsibilities of providing responsive and timely financial reporting, data modeling, statistical analysis and operations support (product operations, clinical, medical management and pharmacy) to guide the overall strategic direction of the Government Line of Business.

Responsibilities:

 

  • Partner with clinical leadership and management in analyzing utilization and medical trends to forecast financial and utilization patterns in order to maximize clinical and operational intervention opportunities.
  • Continually monitor and enhance the effectiveness of the provider pay for performance (P4P) program and member incentive program
  • Collaborate with management, analytical, operational staff and other key internal stakeholders to develop timely action plans to achieve developed strategic goals.
  • Manage the Chronic Disability and Illness Payment System (CDPS) risk adjustment process. This includes management of clinical coding specialists, provider education and outreach and the integration with UPMC shared savings programs. It also includes all data modeling and analytics to support the efforts that result in 3%-5% in additional revenue for the Medical Assistance product.
  • Manage relationships with vendors utilized for various projects, such as predictive modeling risk adjustment, Third Party Liability; relationships via the DHS required Mentor Protege Program, etc.
  • Thoroughly develop, manage, maintain and monitor key business practices put in place to optimize revenue opportunities stemming from risk adjustment revenue platforms. Conduct business in a professional manner with potential vendor relationships in this regard, and establish all budget expectations for this area with the Senior Director of Medical Assistance and other product leadership.
  • Serve as principal Health Plan expert and go-to person on financial reporting and data modeling and analysis. Direct staff in the preparation of studies, revenue and expenditure forecasting / statistical analysis, and other analysis and work to ensure all staff can provide key business recommendations based on the outcomes of their analysis.
  • Develop strategic predictive modeling methods to better understand the various Medical Assistance and CHIP populations and efficient ways to manage and monitor their utilization habits.
  • Effectively work with clinical, operational and financial staff to develop innovative ways to make quality information more transparent to consumers to actively use in their healthcare decision processes. This should be cutting edge within the marketplace, and should be effectively communicated to the consumers, governmental, and other stakeholders.
  • Provide key information to senior management in a timely and comprehensive manner. This includes development of Executive summaries and PowerPoint presentations with the ability to present in executive meetings as needed.
  • Work closely and coordination departmental priorities with Government Product management staff.
  • Work with Government Product management and key leadership in other functional areas of the Health Plan (such as Network, Pharmacy, Provider Services, Member Services, Medical Management, Reimbursement, etc.), analytical and operational staff to analyze and identify key opportunities improving current business practices and determining ways to expand business platforms.

Qualifications

Bachelor's Degree in business finance, statistics, economics, public policy, mathematics, health care management or closely related discipline is required but relevant Master's Degree is strongly preferred. Four to six years of progressively increasing analytical and/or financial experience in a corporate/professional environment, preferably in healthcare. Verifiable experience with Medicaid and/or Medicare managed care is preferred. Proven experience/knowledge of financial and statistical analysis, statutory reporting and program management. Excellent organizational and leadership capabilities with previous staff supervision, mentoring, and development. Above average analytical and problem solving skills. Strong oral and written communication skills. Ability to handle multiple priorities/projects in a fast-paced professional environment. Demonstrated initiative and ability to work independently. Ability to continuously interact effectively and professionally with all levels of Health Plan staff. Demonstrated performance in meeting deadlines and documenting projects, particularly in matrixed environments. Proficient with Microsoft Office products.

Preferences: 
  • Experience with Power BI or Tableau
  • Must have experience with SQL
  • Strong preference for R or Python experience 
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