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 Vice President 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 Vice President 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. This is a highly collaborative role with Health Plan colleagues, especially with Medicare and Medicaid lines of business, key players in the provider network, and community stakeholders to ensure maximum integration of funding, services, and supports for enrolled beneficiaries.This position requires regular onsite presence in downtown Pittsburgh, though we are open to candidates based in other regions of Pennsylvania.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.
Support and inform strategies that affect alignment of CHC and the D-SNP alongside Medicare Product, Risk Adjustment, Finance, Sales and Marketing, Operations, and other related departments.
Participate in development of aligned sales and marketing strategy with Medicare LOB as well as Marketing/Communications Department.
Support and guide strategy for network development, quality improvement, service model design and implementation, and clinical supports.
Lead 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.
Work 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.
Manages staff at the Associate Vice President level and below.
Responsible for managing multi-billion-dollar portfolios in annual operating revenue.
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. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran
