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   Current UPMC employees must apply in HR Direct

Manager, Operations [Risk Adjustment]

Description

UPMC Health Plan is hiring a full-time Manager of Operations to help support the Medicare Exchange Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.

The Manager of Operations will lead implementation activities that support UPMC Health Plan's Exchange strategy, including UPMC Health Plan's participation in the Individual Public Exchange Marketplace. This position is responsible for creating and/or overseeing processes to ensure preliminary and ongoing compliance with all ACA regulations, including but not limited to ensuring UPMC Health Plan meets all filing and reporting requirements.

Responsibilities:
  • Coordinates functions and communications throughout the organization as a hub to ensure the successful delivery of the Exchange program.
  • Assist Compliance/Quality Audit in responding to audit findings and ensure teams are assembled to address deficiencies.
  • Perform requirements gathering, design, testing, and implementation of annual renewal process for ACA membership.
  • Assesses program capacity and capabilities for managing Health Insurance Exchanges and oversees key business functions, processes and the departments supporting Exchange.
  • Manages the implementation of new CMS Exchange product requirements and delineates operational ownership to the appropriate department(s) to ensure they support business objectives and meet all compliance requirements.
  • Proactively identify opportunities to improve processes, draft business cases to support necessary changes, ensure required program and project work gets prioritized and added to Exchange track work plans. Work closely with department teams in the various Exchange tracks to implement recommended changes.
  • Develops and continually improves strategies, objectives and policies for the Exchange program and identifies and resolves any issues that may hinder program success
  • Work with Compliance/Quality Audit to manage process to collect, review and submit risk, quality, and service metrics reporting and ensure reports are submitted as required.
  • Coordinate with other departments to overcome challenges that affect the overall success of the ACA Individual Advantage product.
  • Review, monitor, and incorporate new member communication notices and strategies to maintain membership and adhere to CMS regulated guidelines.

Qualifications

  • Bachelor's Degree in Business Administration or related field 
  • Three or more years supervisory experience in an HMO or other managed care organization, including experience managing large, complex, cross-functional projects in a large matrix organization.
  • Prior experience managing, coaching and leading a large team is highly preferred. 
  • Process Management skills is preferred. 
  • Knowledge and ability to apply advanced features of MS Office applications (Word, Excel, and PowerPoint) and ability to operate database management systems 
  • Excellent organizational skills 
  • Excellent relationship building skills 
  • Excellent verbal, written and presentation skills, including ability to prepare and deliver presentations in a variety of formats and to a variety of audiences 
  • Ability to perform well under pressure when dealing with different types of work and competing and changing priorities 
  • Ability to deal with complex situations

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

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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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