This position has been filled.
University of Pittsburgh Medical Center (UPMC) is a $21 billion health care provider and the largest nongovernmental employer in Pennsylvania, integrating 90,000 employees, 40 hospitals, and 700 doctors’ offices and outpatient sites. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial, and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International.
UPMC Insurance Services Division provides health coverage and benefit management for 3.9 million members, and includes UPMC HealthPlan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health. UPMC Insurance Services Division offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers’ compensation products and service.
UPMC Health Plan’s Commercial HMO product was rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings in 2019-2020. It is among the highest-ranked plans in Pennsylvania. In addition, its commercial PPO/EPO product was rated 4 out of 5 by NCQA. UPMC Health Plan’s large group retention rate is 99%. UPMC Health Plan’s commercial client base includes accounts of all sizes—from two members to more than 100,000. UPMC provides a full suite of insurance products and commercial health plans that include fully insured or administrative services only (ASO) arrangements, and EPO, PPO, and HMO plans.
The Associate Vice President, Medical Affairs Commercial Market will be accountable for ensuring the membership receives exceptional service and that clinical outcomes meet or exceed all standards or benchmarks. He/she assures best standards of practice and promotes person centered, recovery-focused care models and policies working with internal and external stakeholders to represent an integrated approach to health. He/she will be directly involved with interaction of physicians, hospitals, physician practices and related networks, directing and responding to risk management issues, monitoring and implementing programs to improve the quality of medical services provided. This strategic physician leader will be responsible for interaction with UPMC payer/provider clinical leadership (physicians, hospitals, physician practices and related networks) to further insure effective and efficient clinical care of the Commercial membership.
- MD/DO or equivalent degree. Medical Licensure required.
- Master’s degree in business or health related field preferred.
- Senior level manager with at least five years of experience in health care delivery systems management in a managed care environment.
- Strong QI and Utilization background with a working knowledge of finance, management information systems, and statistical analysis.
- Direct experience with NCQA accreditation for managed care organizations.
- Knowledge of an experience with regulatory requirements for the delivery of health plan Commercial products.
- Must demonstrate competency in interpersonal skills and political savvy, analytical, communication, and problem-solving skills, clinical proficiency, team and customer service orientation, the ability to deal with ambiguity and “out of the box” thinking.
- Must possess the ability to interact on an academic as well as community-based level.
- Knowledge and experience with regulatory requirements for delivery of health plan Commercial products.