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

VP, Value Based Reimbursement

Description

Purpose:

Under the administrative direction of the UPMC Insurance Services Division Chief Medical Officer, this senior leader will serve as a strategic, collaborative business partner and is responsible for support of the clinical strategy, operations, and compliance for UPMC Health Plans Value Based Contracting, especially the design and evaluation of clinical and quality strategies. This positions day to day activities will follow the guidance of the VP of Value Based services and it will closely with other members of that team, as well as other clinical and quality leadership. It will be responsible for the development of medical policies and clinical performance standards related to VBPs. This senior leader is accountable for ensuring that VBPs support exceptional service and that clinical outcomes meet or exceed all standards or benchmarks. He/she assures best standards of practice and promotes person centered, recovery-focused care models and policies working with internal and external stakeholders to represent an integrated approach to health. This leader also promotes cost-effective practice patterns through appropriate interventions with health care providers while meeting or exceeding the expectations of internal and external customers by utilizing first-hand member and scientific data for continual improvements in VBP strategies. He/she will be directly involved with interaction of physicians, hospitals, physician practices and related networks, monitoring and implementing programs to improve the quality of medical services provided. This key physician leader will be responsible for interaction with UPMC payer/provider clinical leadership (physicians, hospitals, physician practices and related networks) to further insure effective and efficient clinical care through VBP initiatives.

Responsibilities:

  • Contribute clinical and operational expertise to CMO and all senior management activities at the Insurance Services Division.
  • Represent UPMC Health Plan at local, state and national forums as appropriate and directed in the oversight and management of VBP related quality and clinical services.
  • Participate in the strategic planning of the UPMC Insurance Services Division. Exemplify a collaborative approach to work ethic for staff to model.
  • Establish and monitor the appropriate VBP budgets as assigned.
  • Develop strategies to foster external relationships.
  • Recommend annual plan along with the strategies, tactics and resources for VBP programs necessary to achieve division goals and objectives directly related to the essential functions of the position.
  • Manage the development, implementation, and provision of ongoing clinical evaluation of VBP strategies
  • Work closely with Senior and Executive leadership in developing appropriate VBP strategies specific to each line of business.
  • Provide leadership in advancing appropriate alternative payment models and other future opportunities.
  • Provide support of the provider relations activity for medical management of the lines of business as assigned.
  • Provide strategic guidance of utilization management and medical policy programs/areas as necessary to support all VBP contracts
  • Support and guide the Medical Directors in the assigned lines of business regarding meeting and exceeding standards or benchmarks for quality care and establish benchmarks or standards as needed.

 

Qualifications

  • MD license required.
  • Master's degree in business or health related field preferred.
  • Senior level manager with at least ten years of experience in health care delivery systems management in a managed care environment which included responsibilities with value based contracting models.
  • Strong financial evaluation background with a working knowledge of finance, management information systems, and statistical analysis.
  • Must demonstrate competency in interpersonal skills and political savvy, analytical, communication, and problem-solving skills, clinical proficiency, team and customer service orientation, the ability to deal with ambiguity and out of the box thinking.
  • Must possess the ability to interact on an academic as well as community-based level.


Licensure, Certifications, and Clearances:

  • Doctor of Medicine (MD)

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