Description
Under the administrative direction of the UPMC Insurance Services Division Chief Medical Officer, this senior leader will serve as a strategic and collaborative business partner. This position will also serve as the lead physician for all Government products. In addition, this position will engage with IDFS clinical partners whenever indicated and will be the clinical leader in our government relations activities. The Associate CMO will oversee the management of other physicians, will collaborate with other clinical leadership to ensure the development and implementation of effective services, and is responsible for compliance with all clinical medical policies, directives, rules, regulations, and clinical performance standards related to the identified lines of business, including all relevant accreditation and state and federal government regulations and all accrediting bodies for all lines of business, under the direction of the CMO.
This senior leader is accountable for ensuring the membership receives exceptional service and that clinical outcomes meet or exceed all standards or benchmarks. He/she assures the best standards of practice and promotes person-centered, recovery-focused care models and policies within the division working with internal and external stakeholders to represent an integrated approach to health. This leader also promotes cost-effective practice patterns through appropriate interventions with health care providers while meeting or exceeding the expectations of internal and external customers by utilizing first-hand member and scientific data for continual improvements for products and services. This position will be directly involved with the interaction of physicians, hospitals, and physician practices.
**Responsibilities:**
Contribute clinical and operational expertise to Division CMO, CEO and all senior management activities at the Insurance Services Division.
Manage the development, implementation, and provision of ongoing clinical evaluation of the lines of business as assigned.
Oversee the development implementation and ongoing evaluation of clinical resource management programs and community-based programs.
Oversee the standardization of practice patterns and achieving desired outcomes through clinical resource management and provider benchmarking.
Provide support of the provider relations activity of the lines of business as assigned.
Supervise and guide the Medical Directors in identified lines of business in regards to meeting and exceeding standards or benchmarks for quality care and establish benchmarks or standards as needed.
Represent UPMC Insurance Services Division at various internal and external meetings/conferences. Develop and cultivate strong working relationships with regulatory entities.
Participate in the strategic planning of the UPMC Insurance Services Division. Exemplify a collaborative approach to work ethic for staff to model.
Establish and monitor the appropriate budget as assigned. Select, retain, develop, and reward a competent staff.
Develop strategies to foster external relationships (including state and federal agencies) Recommend annual plan along with the strategies, tactics and resources necessary to achieve division goals and objectives directly related to the essential functions of the position.
Provides oversight for CMOs of Medicare/SNP and Community HealthChoices and Medical AVP of Medicaid.
MD license required.
Master's degree in business or health-related field preferred.
15+ years' experience with 10 in a senior management role with behavioral service delivery of managed care system 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.
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 products including commercial, government products.
**Licensure, Certifications, and Clearances:**
Doctor of Medicine (MD)
**UPMC is an Equal Opportunity Employer/Disability/Veteran**
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
Apply on company website
Find Connections via Linkedin
