Description
Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid.
This role is part of a hybrid team and does have the option of being completely remote.
Performs analysis of data and information for various UPMC products. Take a leadership role in the enhancement, development, documentation, and communication of identified variances. Work with users and developers to identify problems and propose solutions. Maintain project planning documents, prepare materials, write and distribute workflow
Responsibilities:
- Meet deadlines and turnaround times set by managers and department directors (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).
- Perform cost/benefit analysis.
- Identify trends in expenses, utilization, medical quality, and other areas.
- Investigate variances and derive solutions to cost increases and quality issues.
- Perform statistical analyses, and then explain this analysis to a non-technical audience of both internal and external customers and, at times, senior management.
- Manage special projects.
- Monitor business unit operating performance against regional, national and international benchmarks.
- Manage timely and compliant interdepartmental implementation of DHS contract operational requirements.
- Ownership of, and subject matter expert on, DHS required operational reporting. Ensure quality and accuracy prior to report submission to the DHS.
- Manage timely resolution of member and provider escalated issues while communicating frequently with multiple internal and external stakeholders.
Qualifications
Bachelor's degree in mathematics, statistics, health care, management, or related business field required. Master's degree preferred. Extensive related experience will be considered. Minimum of two years of related work experience in financial and/or medical analysis required. Experience in health care insurance or health care industry preferred. Strong computer skills, with expert knowledge in Access, Excel, Crystal Reports, Cognos Reports, and other financial & statistical software packages. The ability to work in a fast-paced environment is a must. Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences. Attention to detail is critical to the success of this position. Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities. Advanced mathematical skills. Ability to interpret and summarize results of various analyses in a timely and meaningful way. Ability to effectively approach problem-solving. Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy. Ability to analyze financial & clinical results and to comprehend forecasting models. Knowledge and a good understanding of all products and benefit designs of UPMC Health.
Preferences:
- Strong preference for advanced Excel skills
- Strong preference for strong problem-solving abilities
- Strong organizational skills preferred
Licensure, Certifications, and Clearances:
- Act 34
- 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.