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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.

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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Senior Medical Director, CHC/Medicaid Products SEPA (Philadelphia)

  • Job ID: 057228847
  • Status: Full-Time
  • Regular/Temporary: Management
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Medical Director Service
  • Location: , Philadelphia PA
  • Union Position: No
  • Salary Range: $0 / hour

Description

UPMC Health Plan is seeking a Senior Medical Director for our Community HealthChoices and Medicaid lines of business in southeast Pennsylvania (510 Walnut Street, Philadelphia). Community HealthChoices is our Managed Long-Term Services and Supports (MLTSS) line of business while Physical Healthchoices (UPMC for You) is our Medicaid line of business.

This Senior Medical Director will be responsible for leading/coordinating adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plans Network and its physicians, hospitals, and other providers. This position will report to the Chief Medical Officer, Community HealthChoices (CHC) with a dotted line relationship to senior medical leadership of the Medicaid team. This Senior Medical Director’s goal is support physician commitment and delivery of comprehensive high-quality health care to our CHC members.

Responsibilities:

  • The UPMC CHC Senior Medical Director will be responsible for supporting clinical activities pertaining to the operation of LTSS and Medicaid programs and services, including preventive care and the management and coordination of primary and other physical health services for these members.
  • The CHC Senior Medical Director will also be responsible for working with the Utilization Management medical director, Care Management leadership, and Behavioral Health Liaison director to ensure integration and/or coordination of physical and behavioral health services and supports.
  • The UPMC CHC Senior Medical Director will also serve as a UPMC medical professional who has key responsibilities in the SE region; he/she faces outward to and interacts with the Plan’s membership and physician community, physician and health system, nursing facilities, home and community-based networks, medical/physical professional associates, government representatives, and advocacy groups to advance clinical excellence and the delivery of cost-efficient care
  • The UPMC Senior Medical Director would be expected to consistently demonstrate the ability to: Develop and drive the organization’s clinical vision and strategy in coordination with senior members of team - ensuring alignment with organization's vision and objectives serve as a change agent and lead change effort; be responsible for maintaining compliance with policies and procedures and implement them; reinforce clinical philosophy, programs, policies, and procedures
  • The UPMC Senior Medical Director will evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes; keep abreast of emerging models in health care delivery; identify new and innovative strategies to achieve CHC goals and objectives; deliver on initiatives relating to optimizing scope of services, clinical quality, patient satisfaction and provider engagement
  • A strong candidate needs to be a strategic thinker; demonstrates command of healthcare issues and trends; effective communicator; excellent written and verbal communication skills; and team player with care and compassion for underserved populations.

 

Qualifications

  • MD or DO required
  • Family Medicine or Internal Medicine required
  • Board certification in Family Medicine or Internal Medicine required
  • Full Time preferred; Part Time possible
  • An unrestricted state license to practice medicine in Pennsylvania
  • Valid driver’s license
  • At least two years of prior managed care experience required
  • Prior experience with LTSS is highly desirable

Proficiency with Microsoft Office Suite (Word, Excel, Power Point).

Licensure, Certifications, and Clearances:

  • MD or DO
  • Board certification in Family Medicine or Internal Medicine required
  • Unrestricted license to practice medicine in Pennsylvania
  • PA Driver's license


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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