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:
