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Manager, Medical Policy

Description

UPMC Health Plan is hiring a full-time Manager of Medical Policy to oversee the Medical Policy  Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.  The ideal candidate will have exceptional leadership and management skills to effectively oversee the operational responsibilities of the department.

Under the supervision of the Senior Medical Director, the Manager is responsible for the day-to-day Medical Policy Team operations through the management of staff and associated activity which includes initiatives as set forth by the clinical leadership and strategic goals of the UPMC Health Plan and IDFS.  The Manager will work collaboratively with the Senior Medical Director to optimize Medical Policy operational performance (service, quality and financial) and ensure all process and outcome measures meet or exceed defined goals.  This includes coordinating functions through the management of staff, which includes annual policy review and policy development and serving as a liaison to internal departments, including Regulatory, Compliance, Benefit Configuration and Network as needed to meet the requirements for completion of medical policies and clinical initiatives, and to promote successful evidence-based outcomes. The Manager builds collaborative relationships with internal and external stakeholders and participates in the development of the departmental strategic business plan to ensure the attainment of the Health Plan's strategic objectives by identifying, recruiting, developing, directing, and evaluating personnel within the department.

Responsibilities:

  • In collaboration with staff, identifies opportunities for improvement and efficiencies.  Ensures that departmental work products meet the highest level of quality.
  • Manages human resource functions for the department including recruitment, orientation, onboarding of new staff, performance evaluations, professional development opportunities, and corrective action plans for staff.  Supervises Medical Policy staff to optimize performance and resolve issues. Makes recommendations for improvement.
  • Coordinates training requirements and professional development opportunities for assigned staff members.Monitors staff participation in mandatory education and competency assessment requirements at the system, Health Plan, and department level.
  • Creates and maintains a culture of service excellence focused on defining, understanding, and consistently satisfying the requirements of both internal and external customers.  Conducts regularly scheduled individualized meetings to communicate information, ongoing education, and/or individual performance feedback.
  • Monitors, coaches, and reports staff productivity.  Manages activities and processes related to Emerging Technology assessment.
  • Conducts regularly scheduled team meetings to communicate key information, engage staff in daily operations, and provide ongoing staff education related to all relevant areas of Medical Policy, while nurturing a team approach.  Serves as a resource to staff and other Health Plan departments to identify opportunities for improvements, and barriers to success.
  • Assures that Medical Policy process flows are efficient.  Provide leadership, oversight, and direction for all assigned special projects and serves on any committees as requested.
  • Manages activities relating to special projects. Ensures compliance with work plans and goals.  Manages the timeliness and accuracy of medical policy assignments to meet established standards.

 

Qualifications

  • Bachelor's Degree in Nursing required.
  • Master's Degree in Nursing or a related field required.
  • 3 years of Medical Policy experience in a health plan payor environment required.
  • 3 years of prior management experience required.
  • Ability to manage staff and resources within established budget guidelines to achieve desired departmental goals preferred.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct