Senior Medical Director MLTSS

BACKGROUND:

As a result of the October 2016 announcement by the Pennsylvania Department of Human Services (DHS) and Aging that the Commonwealth agreed to negotiate and finalize agreements with three managed care organizations (MCO’s) for Community Health Choices (CHC), UPMC For You has an immediate need to recruit a Senior Medical Director, MLTSS. CHC will coordinate physical health and long-term services and supports (LTSS), if needed, to enhance the quality of medical care and access to all appropriate services to more than 420,000 individuals who are dually eligible for Medicare and Medicaid, older Pennsylvanians and individuals with disabilities.

COMPANY PROFILE:

UPMC, (www.UPMC.com) a world-renowned health care provider and insurer based in Pittsburgh, PA., is inventing new models of accountable, cost-effective, patient-centered care. 

UPMC operates more than 20 academic, community, and specialty hospitals, more than 500 doctors' offices and outpatient sites, employs 3,500 physicians, and offers an array of rehabilitation, retirement, and long-term care facilities. UPMC’s Insurance Services Division has grown to three million members.

THE ROLE:

As a result of the July 2017 launch of CHC, the Senior Medical Director will have the rare and exciting opportunity to join a senior team recognized as UPMC's best and brightest leaders.  He/she will shape the way UPMC Health Plans LTSS clinical program is developed and implemented.  As an integral part of the organization, it is paramount that this physician business executive exhibits leadership qualities and expertise that will raise UPMC Health Plan to new levels of excellence and execution.  The success of the UPMC Health Plan For You initiative will rely heavily upon this individual's creativity, discipline, detail and a passion to 'make a real difference' beyond conventional managed care.  He/She will create a standard for measurable clinical excellence by which competitors will be evaluated, resulting in the acquisition of profitable, long-term market share in the region.

RESPONSIBILITIES:

  • Provide clinical leadership and support for Quality Improvement programs, as well as meeting or exceeding all regulatory requirements.  Serve as Clinical Leader for the UPMC For You program.
  • Collaborate with CMO, Medicaid and Behavioral Services to engage all functional areas of MLTSS from a clinical perspective to develop innovative programs as well as products lines; serving as the primary clinical liaison with Network Services, Strategic and Advisory Services, Finance and Underwriting, Marketing, Operations, Information Systems, Pharmacy, and Product Development.
  • As CHC and in particular UPMC expands its membership, motivate and mentor UPMC Health Plan's clinical and Medical Affairs staff by 'setting the pace" and fostering 'excellence by example'

QUALIFICATIONS AND SKILLS:

  • Experience within a health plan or provider organization (with considerable administrative experience) that has truly developed a relationship with the physician and patient community; genuinely collaborative in nature, value-added versus commodity-driven, cross-functionally efficient and consumer-driven. 
  • Must possess a passion and commitment to help change the way healthcare is delivered, in particular with the elderly and disable population, a track record of developing leading-edge clinical strategies while motivating an organization to achieve 'stretch goals' to drive innovation, and do 'what is right today, rather than tomorrow.
  • Expert managed care clinical leadership skills, leveraging a broad knowledge base in managed care.  Must possess a global understanding of the industry:  legislative/regulatory developments, national product and delivery trends, maintenance of key industry relationships and tracking competitors.
  • Exudes a leadership style emphasizing collaboration, teamwork, participation and communication.  Willingness and ability to delegate responsibility to senior subordinates while allowing them room to identify ways and means to ‘take action’ and accomplish specific goals and objectives.

EDUCATION / LICENSURE:

MD or DO license required.  Master's degree a plus.

Organization: 
UPMC
City: 
Pittsburgh
State: 
PA
Date Posted: 
Tuesday, January 31, 2017
Date Closing: 
Tuesday, February 28, 2017
Contact Name: 
Donn Bleau Managing Director - Healthcare Division Solomon Page Group
Contact Email, Phone, or Address: 
dbleau@solomonpage.com 619-291-8499 office
Salary Range: 
Total comp in excess of $300K annually
Full or Part Time: 
Full Time
Keywords: 
MLTSS, LTSS, Medicaid, Medical Director