Description

Purpose:

The AVP of Commercial Products will have the rare and exciting opportunity to join a senior team recognized as UPMC's best and brightest leaders. He/she will shape the way UPMC Health Plan manages all clinical aspects of Medical Affairs. As an integral part of the organization, it is paramount that this physician business executive exhibits leadership qualities and expertise that will raise UPMC Health Plan to new levels of excellence and execution. The success of UPMC Health Plan will rely upon this individual's creativity, discipline, detail and a passion to make a real difference beyond conventional managed care. He/She will create a standard for measurable clinical excellence by which competitors will be evaluated, resulting in the acquisition of profitable, long-term market share in the region.

Responsibilities:

• Swiftly respond to challenges and/or opportunities as they arise. Develop and implement innovative programs to act on historical data, identifying new trends, retooling existing approaches, and analyzing the competition.
• Collaborate with physicians to develop clinical programming by accessing and mining clinical data, devising methods to manage populations.
• Serve on physician committees and work with each Health Management program to monitor, assess and ensure the program's clinical success. Establish best practices for care programs including Diabetes, Asthma, Congestive Heart Failure, End-Stage Renal Disease and Maternity Programs.
• Serve as an integral part in the design and implementation of medical management initiatives such as disease management to improve quality and cost effectiveness of care delivered to Commercial members.
• Collaborate with the Chief Medical Officer to develop unique partnerships and differentiated relationships with current and prospective employer groups, consultants and brokers, in order to understand and meet their health and welfare needs.
• Nurture personal and professional growth/development by attending seminars, workshops, and establishing professional affiliations to keep abreast of latest trends in field of expertise.
• Influence medical cost trend in partnership with network services and medical management team, including development of trend-specific initiatives, provider fee schedule review, and identification of medical management best practices. Create opportunities to integrate pharmaceutical and medical strategy with innovative solutions.
• As an integral member of UPMC Health Plan's leadership team, serve as a role model and health advocate within the Western Pennsylvania community, including active participation with UPMC sponsored activities, public events and community outreach programs.
• Interface with UPMC Health System cross-functional and shared resources to further the cause to create a seamless healthcare patient-flow management process and insurance model.
• Ensure continuous improvement strategies are established and implemented for Health Management outcomes and processes, encouraging a culture which initiates intensive and persistent case management for members.
• Assist with the development of a clinical organization which prioritizes the retrieval and intuitive interpretation and evaluation of statistics and medical trends in order to establish aggressive preventative health targets and objectives.
• Provide clinical leadership and support for Quality Improvement program,
• Collaborate with CMO, and Health Plan senior leadership in the development of short-term, mid-term, and long-range strategic planning for the Health Plan. Partner with physician leaders, and hospital and business executives to exceed clinical, operating, financial, quality, and market share objectives. Deliver executive level presentations for UPMC senior management and other designated groups.
• Identify opportunities to further integrate information systems and departmental interface capabilities, and from a clinical perspective, assist in affecting the 'phase-in' of newly acquired OAO interactive software.
• Collaborate with CMO and to engage all functional areas of the Health Plan from a clinical perspective to develop innovative programs as well as products lines; serving as a clinical liaison with Network Services, Strategic and Advisory Services, Finance and Underwriting, Operations, Information Systems, Pharmacy, and Product Development.
• Motivate and mentor UPMC Health Plan's clinical Medical Affairs staff by setting the pace and fostering excellence by example. Assess the overall team, including ongoing recruitment and hiring of talent. Ensure that the organization has the right people in the right positions and that the organization's structure is designed to maximize results.
• Identify opportunities to further integrate information systems and departmental interface capabilities, and from a clinical perspective, assist in affecting the 'phase-in' of newly acquired OAO interactive software
• Motivate and mentor UPMC Health Plan's clinical Medical Affairs staff by setting the pace and fostering excellence by example. Assess the overall team, including ongoing recruitment and hiring of talent. Ensure that the organization has the right people in the right positions and that the organization's structure is designed to maximize results.

Qualifications

• Doctor of Medicine (MD) required
• Master's Degree is preferred in healthcare, marketing, business administration, or other related fields of study and 5 years' relevant experience.
• Experience in commercial insurance industry highly preferred.
• Extensive experience in clinically leading Medical Affairs within a progressive managed care organization, ideally having created and driven innovative clinical program initiatives as well as having initiated NCQA accreditation and certification.
• Experience within a health plan that has truly developed a relationship with the employer and patient community; genuinely collaborative in nature, value-added versus commodity-driven, cross-functionally efficient and consumer-driven.
• Possess a passion and commitment to help change the way healthcare is delivered, a track record of developing leading-edge Health Plan clinical strategies while motivating an organization to achieve stretch goals to drive innovation, and do what is right today, rather than tomorrow.
• Ability to lead, motivate and mentor superior clinicians in pursuit of progressive programming.
• Solicit support, evaluate, direct and hold ones self and employees accountable, while maintaining high morale and productivity during favorable and unfavorable conditions.
• Expert managed care clinical leadership skills, leveraging a broad knowledge base in managed care.
• Possess a global understanding of the industry: legislative/regulatory developments, national product and delivery trends, maintenance of key industry relationships and tracking competitors.
• Highly developed interpersonal and communication skills, both written and verbal, and an executive demeanor which interacts effectively with all organizational stakeholders regarding sensitive and/or complex topics.
• Ability to plan and schedule multiple tasks/projects and to maintain control of ones own and others work flow to achieve results ahead of schedule and within budget.
• Highly developed analytical skills.
• Operate effectively in a matrix

Licensure, Certifications, and Clearances:

• Doctor of Medicine (MD)

UPMC is an Equal Opportunity Employer/Disability/Veteran

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