Organization Overview
UPMC Insurance Services Division (ISD) includes UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health Organization - offering a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to more than 4.5 million members. Our local provider network includes UPMC as well as community providers, totaling more than 140 hospitals and more than 29,000 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.
UPMC Community HealthChoices (UPMC CHC) is a Managed Long Term Services and Supports (MLTSS) program designed to increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes and communities rather than in facilities and align Medicare and Medicaid benefits. This is accomplished through using mandatory managed care to coordinate health care coverage and improve the quality of health care for participants by allowing them to remain in the community and by giving them the opportunity to work, spend more time with their families and friends, and experience an overall better quality of life.
UPMC CHC is currently one of only 3 plans operating a Medicaid MLTSS program in Pennsylvania, with over 136,000 members and 35% market share. UPMC also operates the second largest Fully Integrated D-SNP program in the nation. Through this, UPMC has one of the nation’s largest and most successful alignments between a Medicare D-SNP and a Medicaid MLTSS. Our over 31,000 aligned participants continue to grow month over month, and they enjoy improved health outcomes and experiences. The aligned population has fewer hospital admissions, increased provision of post-acute home health, lower rate of custodial nursing stays, more HCBS usage and more days living in the community than those in fee-for-service Medicare.
Role Summary
The Vice President has overall product ownership of the Managed Long-Term Services and Supports (MLTSS) program line of business, Community HealthChoices (CHC). In this role, the VP holds responsibility for oversight of CHC line of business performance, profit and loss, membership plan growth and compliance with all regulatory and statutory requirements. The VP will serve as internal and external product lead also overseeing the service coordination function for CHC. The VP will also work toward the goal of the eventual integration of clinical and administrative authority to provide health coverage for dually eligible (Medicaid and Medicare) beneficiaries in an integrated and effective manner. The VP collaborates with Health Plan colleagues, especially with Medicare and Medicaid lines of business, key players in the provider network, and community stakeholders to assure maximum integration of funding, services and supports for enrolled beneficiaries.
Primary Responsibilities
- Oversees the development of the MLTSS products including market development, development of strategic business and project plans to achieve overall health plan objectives for these programs.
- Responsible for profit and loss of MLTSS product.
- Ensures overall performance within the service coordination, customer service center, enrollment services, billing and other supporting departments through critical decision making that ensure regulatory compliance and customer objectives are reached.
- Informs and advises President of UPMC for YOU and State Programs of current trends, issues, problems and activities in functional areas and develop and implement appropriate interventions to facilitate problem resolution and policy making.
- Interacts extensively with internal and external customers and regulators, to build and maintain positive relationships supporting business goals and objectives; act as company/departmental liaison.
- Supports and informs strategies that affect alignment of CHC and the D-SNP alongside Medicare Product, Risk Adjustment, Finance, Sales and Marketing, Operations, and other related departments.
- Participates in development of aligned sales and marketing strategy with Medicare LOB as well as Marketing/Communications Department.
- Supports and guides strategy for network development, quality improvement, service model design and implementation, and clinical supports.
- Leads performance oversight of long-term services and supports providers including service coordination network and integration with clinical coordination and management of beneficiaries in institutional and community settings.
- Works in close collaboration with clinical and medical leadership on program design, efficiency, and outcomes.
- Ensures the attainment of the health plan strategic business objectives by identifying, recruiting, developing, directing and evaluating health plan personnel within the functional area.
- Specifies personnel accountabilities and evaluates performance regularly.
- Establishes and delegates job duties for all positions within the functional area(s). Participates in the design and implementation of training and development programs.
- Manages staff at the Associate Vice President level and below. Responsible for managing multi-billion-dollar portfolios in annual operating revenue.
- Ability to support the creation and implementation of new products and filing as needed.
- Performs other duties as assigned.
Qualifications
- Bachelor’s degree in health care administration, Hospital Administration, Business, Public Health or a closely related field required.
- A minimum of 5 years of management experience; preferably with managed care.
- Experience with Medicaid and/or Long-Term Care is required.
- Experience with Medicare Advantage plans preferred.
- Experience in PA programs strongly preferred.
- Excellent communication skills, verbal, written and interpersonal required.
- Excellent Analytical and problem-solving skills.
- Strong leadership skills and independent decision-making ability.
- Ability to handle multiple direct reports as well as multiple product offerings.
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities.