At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds.

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

Director, Health Management

Description

UPMC St. Margaret is a 222 inpatient and 28 inpatient rehab bed community hospital servicing 6 hospital based clinics and an ambulatory surgical facility located in the Fox Chapel area of Pittsburgh. UPMC St. Margaret is designated as a Magnet hospital through the ANCC and is on the journey to its 4th designation. UPMC St. Margaret stands proud on its foundation pillars of orthopaedics, general surgery, family medicine, and geriatric medicine. UPMC St. Margaret is proudly accredited as a Primary Stroke Center through the Joint Commission and a Center of Excellence for Total Joint Replacement by the UPMC Healthplan. UPMC St. Margaret was recognized in April 2021 as a 5 star hospital through Center of Medicaid and Medicare Services and a hospital safety letter grade A through the Leapfrog Safety Group.

The Director, Health Management is responsible for the development, implementation, and management of an integrated care coordination and health management system that facilitates the promotion, monitoring and continuous improvement of quality of care, quality of service, health care outcomes, patient/family satisfaction and utilization management across the continuum of care, particularly as part of managed care objectives, initiatives and contracts.

Responsibilities:

  • Develop methods for clinical and financial analysis to measure, monitor and evaluate systems, practice pattern, utilization management and care coordination against established goals, standards or benchmarks in areas of cost, qualify of care, qualify of service, outcomes, measures, and patient satisfaction.
  • In conjunction with Medical Director and Education Department, develop and implement educational programs related to care coordination and health management for physicians, care providers, and hospital employees.
  • Serve as a liaison and resource to promote understanding, integration and implementation of care coordination and health management across the hospital, and with clients and key partnerships and networks.
  • Implement and maintain a quality assurance program for the health management programs including collaboration with quality assurance and improvement and risk management.
  • Direct development, implementation, monitoring and improvement of clinical pathways, clinical guidelines, utilization review, and outcome measures and related education systems.
  • Direct the health management program and works with the Medical Director in program planning, goal setting and policy development to support hospital and network mission and strategic plans, particularly managed care contracts and initiatives.
  • Coordinate the development and implementation of administrative policies, procedures, and systems related to health management.
  • Maintain fiscal accountability for areas of responsibility.
  • Supports Medical Director and Clinical Medical Consultants in analysis, development, implementation and evaluation of outcomes and systems improvements across the care continuum.
  • Manage assigned personnel including recruitment, development and evaluation of practice and performance
  • Design tools and systems to facilitate and optimize the care coordination and health management processes across the continuum of care.
  • Responsible for following the mandatory reporting procedures for any incident or serious event that did affect or potentially could have affected the clinical care of any patient
  • Monitor compliance of care coordination and health management practices with internal and external regulatory requirements, laws, policies and procedures, and contracts.
  • Work with directors and managers in hospital and ambulatory care settings to facilitate the operations of care coordination and health management program.

 

Qualifications

  • Knowledge of clinical theory or business management normally acquired through a Master's degree in management or health related field.
  • Knowledge of clinical practice and personnel management normally gained through a minimum of five years of progressively responsible experience including supervision.
  • Broad knowledge of health care provider and payment system including understanding of hospital and ambulatory operations, disease management and insurance experience.
  • Interpersonal skills necessary to effectively interact with medical staff, directors, managers, patient care providers, representatives of external agencies, and patients in hospital and ambulatory care settings.
  • Oral and written communication skills necessary to effectively communicate goals and objectives, resolve interdepartmental and interpersonal issues, and compose reports.
  • Effective presentation skills required.
  • Analytical ability necessary to identify appropriate solutions to complex issues and to evaluate data with regards to resources, operations, care and utilization management.
  • Care Management Certification, preferred


Licensure, Certifications, and Clearances:

  • Clinical Social Worker (CSW) OR Licensed Social Worker (LSW) OR Registered Nurse (RN)
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

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 — 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