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   Current UPMC employees must apply in HR Direct

Director, Medicare SNP

Description

Purpose:
The Director Medicare SNP is responsible for oversight of the of UPMC Health Plan's Medicare Advantage SNP products. The Director will ensure regulatory compliance, member satisfaction, membership growth, financial and operational efficiencies. Maintains direct accountability for reporting, compliance, financial analysis and planning and coordination of efforts with other departments to assure effective operations of the both Health Insurance programs.

*This will be a flexible, hybrid role; reporting into the office and work from home each week. Not 100% remote elgible. 

Responsibilities:

  • Develop annual and longer-term business plans for SNP products
  • Ensure the achievement of product and health plan goals and objectives, including budget goals
  • Develop new products as appropriate
  • Oversee development and execution of business plans and annual operating plan, including employee development, organization goals, network, contracting, and beneficiary and provider relations goals.
  • Oversee development of benefit design and the annual bid
  • Work closely with other plan and system departments to ensure operational and financial goals are met.
  • Ensure operational compliance with all state and federal regulatory agencies.
  • Ensure that the beneficiaries' needs are well served with a strong emphasis on quality operations and innovation.
  • Develop and maintain excellent internal and excellent relationships with key stakeholders including network providers, community organizations, Centers for Medicare and Medicaid Services and other government organizations.
  • Support operations to achieve favorable financial results.
  • Develop and implement strategic and tactical plans to ensure further growth and development of the product and ensure positive financial results.
  • Assist senior management throughout the annual Medicare and SNP product planning process.
  • Serve as the lead for all responsibilities related to long-term care and integrated care planning and implementation process.
  • Lead creation of presentations, Return on Investment (ROI), business case studies, and other essential planning documents for senior level decision-making.
  • Interpret analysis and provide recommendations to ensure the UPMC for Life suite of products are appropriately positioned in the market.

 

Qualifications

  • Bachelor's degree in health administration, business administration, hospital administration, public health or related field required; Master's degree in one of the named fields preferred
  • Critical Leadership Competencies:
    • The incumbent must have:Outstanding leadership and interpersonal/relationship skills with the drive and initiative required to implement change at the strategic and operational levels.
    • At least 5 years' experience in Medicare Advantage or managed care preferred
    • Demonstrated experience in managing SNP products preferred
    • Strong understanding and/or experience with Managed Long Terms Supports and Services products such as CHC, the Pennsylvania MLTSS program preferred
    • Product development experience
    • Strong oral and written communication skills
    • Excellent analytical, strategic and operational oversight skills.
  • The following competencies are desired of this individual:
    • A strong balance of strategic and business skills, with a high level of intellectual agility and capacity for original thoughts.
    • Ability to instill within the organization a rigorous analytical approach to each aspect of their work from performance management and vendor selection to underlying root cause analysis.
    • A passion and knowledge to inspire others to introduce new perspectives order to find the best solutions and evaluate effectiveness of these initiatives
    • Willingness to take risks
    • Emotional intelligence
    • Exceptional interpersonal skills who can relate well with people at all levels of the organization and demonstrates sensitivity to others
    • Balanced leadership style that allows for both hands-on and strategic leadership skills, with the ability to lead by example
    • Results-oriented with a bias toward action
    • High standards for self and team.
    • Successfully achieves goals and remains persistent through obstacles
    • Maturity to stay focused and work well under pressure.
    • Honed consensus building and relationship development skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct