President, UPMC Medicare Products

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President, UPMC Medicare Products Job ID: 8219015090 Status: Full-Time Regular/Temporary: Executive Shift: Day Job Work Arrangement: Hybrid Facility: UPMC Health Plan Department: Administration Location: 600 Grant St, Pittsburgh, PA Union Position: No Salary Range: $ 0.0-0.0 USD APPLY NOW SAVE JOB Under the general direction of the President and CEO of the UPMC Health Plan, the President, Medicare Products is responsible for overall Medicare product performance, strategic direction and related program development and implementation provided by Medicare products and programs to ensure compliance with the goals and objectives established by Executive Leadership and the Board of Directors. The President is responsible for all aspects of the Medicare products and program functioning, clinical and business. Responsible for achieving top-line revenue objectives and bottom-line profitability targets while maintaining/enhancing customer and provider satisfaction. This executive will work with a broad spectrum of UPMC administrative and physician leaders to lead the overall strategy of the Health Plan’s Medicare programs and Veterans programs. Jointly responsible with clinical leadership for developing and maintaining clinical and quality (STARS) programs necessary to meet business goals related to quality and care management standards as well as financial targets. This role will also identify and develop strategy for operational management and development to meet organizational performance plans within agreed upon timeframes. Additionally, responsible for establishing and maintaining appropriate systems for measuring compliance, operational management, and development of the UPMC for Life programs necessary to meet program requirements. The President will also be a liaison between the Health Plan business units and acts as the primary contact with the CMS and related governmental agencies. This position is also responsible for: Risk Adjustment (organizational) Responsibilities Participate with UPMC Executives and the Board of Directors to define, develop and implement programs and services for the Medicare products and programs. Monitor the adequacy of UPMC for Life’s activities through coordination with the Board, Medical Directors, and administrative staff, and ensure the policies needed to provide acceptable managed care services are developed and implemented. Promote managed care services that are produced in a cost-effective manner while maintaining a high level of quality, achieving 4.0 or higher STAR Ratings for core products. Ensure compliance with all regulatory agencies governing managed care services and the rules of accrediting bodies by continually monitoring the organization’s service delivery and initiating changes as required; directly oversee public policy activities related to all Medicare products and activities. Recommend company policy positions concerning legislation, government administrative policies and health care initiatives for Medicare. Directs, manages, and controls departmental expenditure within agreed budget. Establish growth targets, as approved via budget process. Develop and implement sales/ marketing and product development plans to exceed short-term and long-term targets. Works collaboratively with Marketing for member material development, branding initiatives, public relations, mass media strategy, and overall marketing budget management. Establishes and maintains appropriate systems for measuring necessary aspects of program performance. In concert with Operations, ensure Medicare operational processes meet regulatory and product performance standards and develop/monitor action plans needed to support any needed improvement. Maintain good relations with UPMC physicians and hospitals/facilities and non-UPMC network to advance product goals and requirements. Manages and develops a competent staff. Responsible for directing annual bid/benefit Medicare Advantage product filing process and recommending product development direction to CEO/UPMC/Board Leadership. Support development, along with senior clinical leaders, of Medicare care and utilization management processes and program development. Leads essential Medicare Sales Functions: Management of broker sales managers and staff. Management of multiple sales distribution channels, including external General Agent and broker network. Develop and maintain external commission plan. Coordinate commission payment processes with Finance. Develop and update the overall broker business plans/strategies. Participate in the development of training programs for the various distributions. In conjunction with commercial sales department, develop strategies for employer group regarding retiree offerings. Comply with sales regulatory requirements. Ensure proper resources are available. *Performs in accordance with system-wide competencies/behaviors. *Performs other duties as assigned. Qualifications: Educational and Knowledge Requirements Bachelor’s degree in business, health care or financial studies or related field, Masters preferred. Minimum of ten years of experience in managed care setting primarily related to Medicare programs. Excellent verbal and written communication skills, as well as analytical and organizational skills are required. Extensive problem-solving experience is required. Excellent managerial, financial, analytical, organizational, and customer service skills are key. The ability to continuously interact effectively with all levels of management is critical. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran APPLY NOW SAVE JOB SHARE JOB CAREER GROWTH Grow Your Nursing Career Spanning over 20 clinical specialties and more than 50 unique nursing roles, every nurse at UPMC can achieve and advance their goals with the My Nursing Career Ladder. Whether you’re looking to progress to an elevated role or continue your education, UPMC equips nurses with the resources, feedback, leadership, and benefits to help you succeed and achieve your career goals. Here’s how a few nurses have grown their careers through the years at UPMC: Clyde C. Michelle B. Clyde C. Clyde C. As a Professional Staff Nurse, Expert at UPMC Muncy, Clyde is a great example of someone who has taken advantage of UPMC’s My Nursing Career Ladder to grow his career while remaining in the same hospital location. Clyde’s Career Journey: ⦁ 2017: Professional Staff Nurse – UPMC Muncy ⦁ 2021: Sr. Professional Staff Nurse – UPMC Muncy ⦁ 2022: Sr. Professional Staff Nurse II – UPMC Muncy ⦁ 2022-present: Professional Staff Nurse, Expert – UPMC Muncy Michelle B. Michelle B. In her current role as a Professional Staff Nurse, Expert at UPMC Presbyterian, Michelle cares for patients with chronic and ongoing health issues as part of a Medical-Surgical unit. Michelle enjoys the daily change that Med-Surg nursing brings, and has found a career path that is interesting, meaningful, and full of opportunity. Michelle’s Career Journey: ⦁ 2019: Staff Nurse – UPMC Presbyterian ⦁ 2020: Professional Staff Nurse – UPMC Presbyterian ⦁ 2021: Professional Staff Nurse, BSN – UPMC Presbyterian ⦁ 2021: Sr. Professional Staff Nurse, BSN – UPMC Presbyterian ⦁ 2022: Sr. Professional Staff Nurse II, BSN – UPMC Presbyterian ⦁ 2023: Professional Staff Nurse, BSN, Expert – UPMC Presbyterian INSURANCE SERVICES DIVISION OF UPMC Advance Your Future A career with UPMC means more than just caring for patients – when you’re a part of UPMC Insurance Services Division, it means caring for more than four million insurance members, too. UPMC Insurance Services Division offers a full range of health insurance products and services to our network across the country, providing peace of mind, better health, and financial security to our members, along with limitless career opportunities and a rewarding mission to those on our team. About Us Opportunities on Our Team Recognized for Excellence Jump-Start Your Career About Us About UPMC Insurance Services Division As an integrated health care provider-insurer, UPMC goes beyond patient care to provide insurance products and services to millions of members. Our team partners with UPMC and community network providers to deliver knowledge and expertise that provides the highest quality care at the most affordable price, supporting our members through service, communication, and more. Fast Facts: We provide insurance products and services to over more than four million members. UPMC’s Insurance Services Division offers a full range of health insurance options including UPMC Health Plan, Workpartners, UPMC for Life , UPMC for You , UPMC for Kids , UPMC Community HealthChoices, and Community Care Behavioral Health. UPMC Health Plan is among the nation’s fastest-growing health plans. Opportunities on Our Team Opportunities on Our Team We’ve got a job that’s just right for you! UPMC Insurance Services Division team offers a vast array of career paths and opportunities , from career areas like customer service, data analytics, and information technology and even patient care roles like social work, nursing, and care management. Whether in non-clinical or patient-facing roles, our team impacts patients and members by providing quality experiences before, during, and after their care, building relationships in a unique and meaningful way. Search Jobs Recognized for Excellence Recognized for Excellence Be a part of an award-winning team! UPMC Insurance Services Division has been recognized for outstanding care and service with awards that include: U.S. News and World Report named UPMC for Life a “Best Insurance Company for Medicare Advantage” in Pennsylvania for 2024. The Human Rights Campaign Foundation has named UPMC Health Plan an “Equality 100 Leader in LGBTQ+ Workplace Inclusion” for 2023–2024. UPMC for Life ranked #1 in Customer Satisfaction* among Medicare Advantage Plans in Pennsylvania by J.D. Power. The Ethisphere Institute named UPMC as one of the World’s Most Ethical Companies for the sixth consecutive year. *Results are based on award-eligible plans in Pennsylvania by J.D. Power. For J.D. Power 2024 award information visit, jdpower.com/awards . Jump-Start Your Career Jump-Start Your Career Looking to launch a career with longevity and opportunity? With countless entry-level opportunities for recent graduates, along with tools and resources that empower you as you learn and grow, UPMC Insurance Services Division is the perfect place to get a career started. Interested in taking your career to new heights? Our career paths and advancement opportunities will provide you with chances to achieve your goals at every step. Search Jobs BENEFITS AND LIFE AT UPMC Why Work Here We know that you have many options when choosing where to build your career. So why choose UPMC? We can think of a few reasons. Work-Life Balance Finding the ideal balance to manage the important elements in your life. Development & Opportunities Enhancing your career through continued learning opportunities and/or advancement. Compensation Receiving competitive pay for the work that you do – base pay, merit, and premium pay. Performance & Recognition Rewarding performance that supports the goals and mission of UPMC. Benefits Providing assistance and security to meet the current and future needs of you and your family. Work-Life Balance Finding the ideal balance to manage the important elements in your life. Development & Opportunities Enhancing your career through continued learning opportunities and/or advancement. Compensation Receiving competitive pay for the work that you do – base pay, merit, and premium pay. Performance & Recognition Rewarding performance that supports the goals and mission of UPMC. Benefits Providing assistance and security to meet the current and future needs of you and your family. Benefits that Matter to You We’re committed to providing benefits that meet your needs and support your well-being in all areas of life. Earn over 5 weeks of paid time off every year Affordable medical, dental & vision coverage Student loan assistance and tuition reimbursement options Earn up to 8% of your eligible pay in retirement contributions from UPMC Employer-paid life insurance Benefits that Matter to You We’re committed to providing benefits that meet your needs and support your well-being in all areas of life. Earn over 5 weeks of paid time off every year Affordable medical, dental & vision coverage Student loan assistance and tuition reimbursement options Earn up to 8% of your eligible pay in retirement contributions from UPMC Employer-paid life insurance Benefits that Matter to You We’re committed to providing our employees with benefits that meet their needs and support their well-being in all areas of life. Earn over 5 weeks of paid time off every year Affordable medical, dental & vision coverage Student loan assistance and tuition reimbursement options Earn up to 8% of your eligible pay in retirement contributions from UPMC Employer-paid life insurance Support for You – and Your Family Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family. Two weeks of paid parental leave Family planning resources Tuition assistance for dependents Comprehensive health care for dependents Emergency child and elder care options Flexible work arrangements Support for You – and Your Family Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family. Two weeks of paid parental leave Family planning resources Tuition assistance for dependents Comprehensive health care for dependents Emergency child and elder care options Flexible work arrangements Support for You – and Your Family Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family. Flexibility to choose the shifts and work arrangements that work best for your lifestyle Two weeks of paid parental leave Family planning resources Comprehensive health care for dependents Emergency child and elder care options A Culture That Cares At UPMC, you can find a home among people who share your passions and care about who you are. Employee resource groups Awards for champions of dignity & respect Center for Workplace Culture and Engagement Programs for veteran engagement A Culture That Cares At UPMC, you can find a home among people who share your passions and care about who you are. Employee resource groups Awards for champions of dignity & respect Center for Workplace Culture and Engagement Programs for veteran engagement A Culture That Cares UPMC is a place where you can find a home, no matter your gender, race, sexual orientation, age, or culture, and where you can meet people who share your passions and care about you. Employee resource groups Awards for champions of dignity & respect Center for Workplace Culture and Engagement Programs for Veteran Engagement Tools to Reach Your Potential Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams. Up to $6,000 of annual tuition assistance Ongoing learning via LinkedIn Learning Accelerated career pathways for growth Robust instructor-led education and learning pathways Tools to Reach Your Potential Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams. Up to $6,000 of annual tuition assistance Ongoing learning via LinkedIn Learning Accelerated career pathways for growth Robust instructor-led education and learning pathways Tools to Reach Your Potential Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams. Unlimited educational possibilities, including no-cost BSN and MSN programs Robust career ladders for every nurse – no matter your specialty, location, or career stage Up to $6,000 of annual tuition assistance Ongoing learning opportunities Expansive Opportunity Where do you want to go with your career? Wherever it is, UPMC can take you there. 100,000 employees 40+ hospitals and 800+ doctors’ offices and outpatient sites Dozens of career ladders to climb International locations State-of-the-art technology Expansive Opportunity Where do you want to go with your career? Wherever it is, UPMC can take you there. 100,000 employees 40+ hospitals and 800+ doctors’ offices and outpatient sites Dozens of career ladders to climb International locations State-of-the-art technology Expansive Opportunity Where do you want to go with your career? Wherever it is, UPMC can take you there. 100,000 employees 40+ hospitals and 800+ doctors’ offices and outpatient sites International locations State of-the-art technology LEARN MORE ABOUT BENEFITS * Note: Benefits described may not be applicable to all staff. Read More about Nursing at UPMC Never Too Late: Kendra’s UPMC Journey After working as a nursing assistant for 16 years, Kendra took the leap to go back to nursing school and become an RN. LEARN MORE Med-Surg Nursing in 4 Words: UPMC Nurses Share We asked our nurses to shed some light on what Med-Surg nursing means to them. Get to know Med-Surg nursing – in four words – from UPMC nurses! LEARN MORE Where Passion Meets Purpose: Leah’s UPMC Story Starting her career in Environmental Services, Leah shares how she fell in love with health care and became a nurse. LEARN MORE Read More about UPMC Insurance Services Division Why Data Analytics Matter to UPMC’s Mission In UPMC Insurance Services Division, analysts work to understand, innovate, and improve the products and services UPMC provides. LEARN MORE The Game of Life is About More Than Winning: Eddie’s UPMC Outlook Eddie S. shares how his passion for football, fishing, and friendship shapes his life and his career with UPMC Health Plan. LEARN MORE From the U.S. Army to UPMC Health Plan We asked our nurses to shed some light on what Med-Surg nursing means to them. Get to know Med-Surg nursing – in four words – from UPMC nurses! 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