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   Current UPMC employees must apply in HR Direct

Manager, Government Products-Operations

  • Job ID: 224705270
  • 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: $32.46 to $55.43 / 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 will be responsible for the operational oversight of all Government products including the enrollment data and the performance. The manager is expected to operate the business and financial operations related to Government product lines. The role will pull data and provide best practices benchmarks and standards to measure Health Plan operating performance are achieved.

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

Qualifications

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. This individual will also have extensive Medicaid product knowledge. Other qualifications include: Four year Bachelor Degree from an accredited college or university, MBA is a plus. Five or more years' experience in medical assistance or government programs 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.

Preference:
  • Must have 1-2 years of Insurance 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