COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

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.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Director, Medicare Compliance

Description

Purpose:
Under the direction of the Senior Director, the Medicare Compliance Director is responsible for managing the Medicare compliance programs and where necessary, certain Internal Audit reviews, including ongoing risk assessments, education/training programs, regulatory reviews, coordinating compliance activities throughout the UPMC Health System, etc.

Responsibilities:

  • Oversee and participate in CMS mock audits of departments
  • Ensures ongoing monitoring activities and compliance reporting mechanisms are documented to demonstrate compliance oversight
  • Facilitate the Medicare Operations Compliance Committee comprised of senior management in the absenceof the Medicare Compliance OfficerParticipate in CMS program audits: preparation, oversight of information provided, answering questions of auditors and making presentations to auditorsManage the dedicated Medicare compliance staff
  • Responsible for ongoing oversight of FDR compliance with Medicare Advantage regulations
  • Participate in performing risk assessments internally and externally (FDRs)
  • Work collaboratively with quality assurance department and the operational departments to identify changes in CMS audit protocol universe pulls, performing targeted audits, and identifying the need for focused audits
  • Review, research, interpret, and summarize federal regulations and ensure timely training of key personnel and FDRs impacted by new or changed regulations in addition to Medicare compliance topics
  • Oversee compliance training regarding CMS regulations for operational departments and FDRs
  • Oversee the issuance of notices of non-compliance, as applicable
  • Oversee the development of corrective action plans for all departments and FDRs when areas of non-compliance have been identified, and monitor the actions to ensure remediation
  • Help lead implementation of regulations related to compliance
  • Oversee weekly CMS communications to UPMC Health Plan staff as well as monitoring reports and corrective action plan implementation
  • Review policies and procedures to support Medicare compliance and ensure they meet the intent of CMS regulations
  • Participate as a committee member of the Medicare Operations Compliance Subcommittee
  • Assist the Medicare Compliance Officer with the Medicare Operations Compliance Committee meetingagenda, meeting minutes, etc.

 

Qualifications

  • Bachelor’s degree required; advanced degree in health-related field preferred

  • At least 5 years' experience in a Medicare Advantage compliance program required

  • At least 5 years' experience in managing staff

  • Knowledge of CMS, Medicare Part C and Part D regulations

  • Knowledge of federal healthcare laws, regulations and guidance

  • Excellent planning, organizational, documentation, analytical, and problem-solving skills

  • Ability to work independently, manage multiple projects and meet scheduled deadlines

  • Ability to identify root cause issues and to oversee appropriate corrective actions are developed and implemented

  • Developed analytical, problem-solving and highly developed interpersonal skills are required

  • Strong organizational skills with attention to detail

  • Proficiency in applying and interpreting rules associated with Medicare regulations

  • Excellent written and verbal communication skills required

  • Ability to effectively lead, supervise, and interact with employees in all levels within the organization

  • Strong computer skills required


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct