UPMC is looking for a Director, Government Product Analytics to support our Community Heath Choices team! This role will be based out of our Pittsburgh office.
Community Health Choices will impact more than 400,000 people statewide who are dually eligible for Medicare and Medicaid or receive Medicaid funded long-term services and supports (LTSS). Through Community HealthChoices (CHC), we will coordinate physical health care and LTSS to enhance the quality of life and independence for frail seniors and adults with disabilities in home and community based environments as well as in institutional settings.
The Director, Government Product Analytics is responsible for all aspects of comprehensive analysis of data and information for government products. Responsible for team of Business Analysts who perform day to day financial and product analyses. The Director, Government Products Analytics takes a leadership role in the enhancement, development, documentation, and communication of identified variances. To successfully perform this role, the Director must understand the causes of financial & clinical trends and anomalies as well as strategic positioning. Maintains direct accountability for reporting, financial or market analysis, planning and budgets. This position will manage the organization of all data and information gathered to support, and monitor the performance of the Health Plan's initiatives in accordance with company requirements and customer expectations. The Director, Government Products Analytics has knowledge and expert understanding of financial, clinical and other information generated by numerous sources to identify opportunities to improve clinical and financial performance and develop budgets. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. These functions must be done while also weighing the practical considerations and potential barriers that exist when successfully implementing new programs and processes.
Develop a library of standard analytical reports for internal use and presentation to external customers to support analysis and recommendations.
Develop, monitor and oversee product performance, including reporting that integrates government product data as necessary.
Identify trends, investigate variances, and derive solutions to cost increases and quality issues.
Implement and monitor effectiveness of analysis and recommendations.
Inform and advise management of government products of current trends, issues, problems and activities in functional areas, and develops and implements appropriate interventions to facilitate problem resolution and policy making in conjunction with changes resulting from corporate and ISD direction, as well as Healthcare Reform.
Lead the analysis of claims experience, utilization, quality, membership and other statistics for all facets of the UPMC Health Plan resulting in recommendations that improve performance and demonstrate value.
Monitor UPMC Health Plan operating performance against regional, national and international benchmarks. Mentor varying levels of Business Analysts
Participate in the development and implementation of the government products strategic business plans and project plans to achieve Health Plan objectives.
Partner with subject matter experts in Finance, Operations, Clinical, Pharmacy, Sales/Marketing, and other areas to develop analyses and recommendations.
Responsible for all analytical supporting functions of the government product lines; including (but not limited to): Pay for Performance design, pricing, implementation and evaluation; Care and Disease Management program modeling, vendor relationships, HEDIS and quality care initiatives; gain sharing opportunities, forecasting, other clinical initiatives; pharmacy reporting, benefit design, enrollment, etc.
Support development of training / mentoring curriculum that teaches varying levels of analysts how to effectively analyze and present recommendations and demonstrate value.
Support the UPMC Health Plan through timely and responsive research and analysis
Bachelors degree in business, public health, mathematics, statistics, healthcare, management or related field required, Masters degree in these same areas preferred.
Minimum of five years experience in managed care and/or Medicaid, Medicare, or long-term services and supports.
Superior computer skills including Microsoft Access, Microsoft Excel, SAS, Crystal Reports, SQL, Toad, and other financial & statistical software packages.
Minimum of five years supervisory/management experience required
Strong prioritization and project management skills as well as in-depth healthcare business knowledge combined with thorough understanding of analysis and presentation, underlying business processes and the ability to assess how process changes impact organizational performance
Ability to proactively prioritize time-sensitive requests for information with finite resource.
Ability to negotiate effectively with other departments / divisions for knowledge transfer, influence and coach decision makers vis a vis best approaches, interpret results and advise internal customers on underlying trends / potential causes as well as recommended course of action
Person must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis
Ability to work in a fast-paced environment a must
Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity
Strong leadership skills and independent judgment and decision-making ability
Internal Number: 689400
About UPMC Health Plan
UPMC Health Plan, headquartered in Pittsburgh, Pa., is among the nation's fastest-growing health plans. It is owned by UPMC, a world-renowned health care provider. As part of an integrated health care delivery system, UPMC Health Plan is committed to providing its members better health, more financial security, and the peace of mind they deserve. UPMC Health Plan partners with UPMC and community network providers to produce a combination of knowledge and expertise that provides the highest quality care at the most affordable price. The UPMC Insurance Services Division — which includes UPMC Health Plan, UPMC WorkPartners, LifeSolutions, UPMC for Life, UPMC for You, UPMC for Kids, Askesis, 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 services to over 3.2 million members. Our local provider network includes UPMC as well as community providers, totaling more than 130 hospitals and more than 20,000 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.