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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

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   Current UPMC employees must apply in HR Direct

AVP, Medicare Medical Services

Description

Under the direction of the CMO, Medicare & Special Needs Products, this position is responsible for medical management and other key leadership roles in strategic initiatives of Medicare. The position will not only help to direct the related medical operations of these products, but will support the development of reliable and innovative clinical processes, analytics and novel product development that produce excellent results for our members and our plans. In this role, the AVP will work collaboratively with other leaders of this product to oversee operational and financial goals and orchestrate improvements that address trends related to complex issues in quality and care management, as well as provider relations. The AVP will serve as a role model in upholding the values, business objectives, and service expectations of the UPMC Insurance Division. Finally, the AVP will supervise other medical staff assigned to these products and work closely with analytic and product leadership.

Responsibilities:

  • Work with physician, nursing, and operations leaders to advance UPMC capabilities in the development of chronic care program
  • With other physician leaders, advance the professional development, resiliency, engagement, and alignment of all caregiver
  • Organizational Leadership
  • Define and manage resources (including, but not limited to, Medical Directors, other clinical staff) to deliver strategic and operational goals for Medicare and chronic care initiatives
  • Develop and mentor physicians and other managers as effective leaders, achieving high engagement levels
  • Serve as an executive role model for the expression of UPMC core values and mission
  • Align Medicare products with new and emerging Regulatory requirements and policies
  • Consult to SNP and CHC product teams regarding care strategies and plans
  • Represent the Medicare products and Health Plan in public settings as needed
  • Develop and direct clinical strategies to achieve more favorable quality and financial results for the Medicare product.
  • In collaboration with other additional leadership, develop and lead chronic care initiatives for the Medicare plan
  • Strategy Development
  • Collaboratively support and develop strategic, tactical and financial plans to optimize Medicare product and quality performance and member experience; ensure continued product growth and development and ensure that beneficiaries' needs are well served with a strong emphasis on quality and value
  • Leverage technology as appropriate to optimize product and program performance and member engagement and benefit
  • Thought Leadership
  • Stay abreast of innovative care delivery models and trends; gather, adapt, and apply market intelligence to inform design of innovative Health Plan products, programs, and business opportunities
  • Provide oversight of and strengthen performance in care for ambulatory, episodic care, and risk-based populations
  • Collaborate with departments to work cohesively toward clinical, operational and strategic goals
  • Collaborate in the development of benefit design and contribute to the annual bid
  • Operations ManagementIn partnership with other Medicare leaders, establish operational and financial goals for products and programs; actively monitor trends and manage performance against goals
  • Define and drive implementation of analytics and information systems for management and reporting of Medicare products and Chronic Care programs
  • Develop and maintain effective internal relationships with key stakeholders including network providers, community organizations, CMS and other government organizations

 

Qualifications

  • Minimum ten years clinical experience.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school.
  • Unrestricted License in Pennsylvania.
  • Post residency clinical experience.
  • Clinical experience in geriatrics or other disabled populations preferred.
  • At least ten years of management experience preferred.
  • Experience in managed care setting preferred.
  • Ability to implement medical policies, and to enforce those policies through appropriate action.
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care. 
  • Ability to implement programs of quality care analysis, peer review, and professional education.
  • Board Certification in ABMS American Board or Medical Specialists preferred


Licensure, Certifications, and Clearances:

  • Board Certification in a ABMS specialty required (a second Board certification is helpful but not required.)
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct