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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Director, Medical Cost Economics

Description

The Director of Medical Cost Economics is responsible for developing and driving medical cost improvement strategies for UPMC Health Plan. This includes analyzing medical cost utilization and unit cost data, identifying top trend drivers and affordability opportunities, developing strategies across cross functional teams such as Affordability, Clinical, Network ? Value Based, and Payment Integrity, and supporting the execution of those strategies. The Director of Medical Cost Economics should have strong analytic and data skills as well as an ability to influence and leverage cross functional teams.

Responsibilities:

  • Identify medical cost affordability opportunities.Monitor historical and current data trends in order to make recommendations and predictions.Access and analyze data from a variety of sources to create a cohesive story.
  • Present data and analysis in a meaningful and easy to understand manner to influence and provide guidance on data driven strategic decisions.Leverage local market, regional, and functional (network, clinical, payment integrity, etc.) subject matter experts to optimize the value of affordability initiatives across the organization.
  • Direct and influence cross-functional teams to adopt new ideas, solutions, and approaches.Measure the potential impact of affordability initiatives.
  • Translate complex concepts in ways that can be understood by a variety of audiences.Solve unique and complex problems with broad impact on the business.
  • Identify and resolve technical, operational and organizational problems outside own team.Predict emerging customer needs and develop innovative solutions to meet them.Participate in the development of business strategy.

 

Qualifications

  • Requires a BS/BA degree.
  • FSA required from the Society of Actuaries (SOA).
  • 5+ years of overall professional work experience.
  • 2+ years working with a health insurer, managed care organization, or similar healthcare related experience.
  • 2+ years of experience leading complex projects across cross functional teams.Intermediate level of proficiency in Microsoft Excel, Word, and PowerPoint.
  • Self-sufficiency with the acquisition and analysis of data including SAS and/or SQL.
  • Undergraduate degree.
  • Solid written and verbal communication skills including well-developed interpersonal skills used to influence the behavior of others, some of whom will be at executive levels.
  • Ability to multi-task, shifting back and forth effectively among multiple activities.
  • Excellent analytic and problem-solving skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

 

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