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 which includes UPMC HealthPlan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health — 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 Commercial HMO was rated 4.5 out of 5 in NCQA Private Health Insurance Plan Ratings in 2019-2020. UPMC Health Plan PPO/EPO, Medicaid, and Medicare products were ranked 4 out of 5 in 2019-2020.
The Chief Quality Officer and Vice President of Quality Improvement and Performance will be responsible for leading the quality of care and best practice guidelines, ethical standards and protocols, and clinical outcomes for all UPMC Health Plan lines of business. This key leader will:
- Lead a 3.9 million-member health plan’s quality operations and strategies for new clinical care models, population health, alternative payment programs and regulatory compliance.
- Continue the turnkey drive for impeccable quality vision, mandate excellence in quality goals, and recommend critical organizational changes to achieve those goals.
- Oversee development of strategy and methodology for performance-based quality, cost of care, and member experience in supporting physician and provider payment reform.
- Direct the use of data, best practices, and benchmarks to analyze provider performance, and provide tools and strategies to facilitate network quality improvement.
- Doctor of Medicine/Doctor of Osteopathy strongly preferred.
- Minimum of seven years of quality management experience in a managed care environment; 10+ years of experience highly desirable.
- Experience with health insurance plans and with NCQA accreditation for managed care organizations.
- Demonstrated knowledge and experience with clinical quality management and improvement concepts, techniques, processes, and outcome measures.
- Comprehensive understanding of HEDIS and HCAHPS specifications and methodology.
- Well-developed analytical and problem-solving skills with the ability to understand, interpret, manipulate, and evaluate clinical and statistical data.