MEDICAL DIRECTOR, COMMERCIAL PRODUCTS

Job ID: 7106155836
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Medical Director Service
Location: 600 Grant St, Pittsburgh, PA
Union Position: No
Salary Range: $ 0.0-0.0 USD

QUALIFICATIONS:

• Doctor of Medicine or Doctor of Osteopathy from an accredited school.
• Pennsylvania Medical License
• Experience managing commercial plans
• 5-10 years of clinical experience in any specialtyLicensure, Certifications, and Clearances:
• Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

PURPOSE:

The Medical Director, Commercial Products will possess extensive experience in clinically integrating a Sales and Retention team, ideally having had experience creating and driving innovative employer clinical program initiatives, as well as having a keen understanding of population health management. The Medical Director, Commercial Products will also have experience within a health plan that has truly developed a relationship with the employer, employee, and provider community; that is genuinely collaborative in nature, value-added versus commodity-driven, cross-functionally efficient, and consumer-driven. They should also have experience in an ongoing engagement process with employer groups and will possess a passion and commitment to help change the way healthcare is delivered, as well as a track record of developing leading-edge Health Plan clinical strategies for employer engagement while motivating an organization to achieve ‘stretch goals’ to drive innovation. Expert managed care clinical leadership skills and being able to leverage a broad knowledge base in managed care is needed. The Medical Director must also possess a global understanding of the industry: regulatory developments, national product and delivery trends, maintenance of key industry relationships and tracking competitors.

RESPONSIBILITIES:

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• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.
• As a clinical ‘thought leader’ and UPMC Health Plan physician liaison, participate in the creation of opportunities to consult, interact and elicit feedback with the physician community, then act upon this valuable information, raising proactive clinical intervention to unprecedented levels.
• As an integral member of UPMC Health Plan’s leadership team, serve as a ‘role model’ and ‘health advocate’ within the Western Pennsylvania community, including active participation with UPMC sponsored activities, public events and community outreach programs.
• Collaborate with AVP of Commercial Products and CMO of Clinical Operations and Commercial Products, as well as Commercial Line of Business leadership to engage all functional areas of the Health Plan from a clinical perspective, developing innovative approaches for the advancement of the Commercial product lines; serving as the primary clinical liaison with the Senior Medical Director of Commercial Products, Sales and Marketing.
• Collaborate with the Chief Medical Officer, ISD, and executive clinical leadership to develop unique partnerships and differentiated relationships with current and prospective employer groups, consultants and brokers, in order to understand and meet their health and welfare needs.
• Interface with UPMC Health System cross-functional and shared resources to further the ’cause’ to create a seamless healthcare patient-flow management process and insurance model based on the needs of the Commercial line of business.
• Motivate and mentor UPMC Health Plan’s clinical Commercial staff by ‘setting the pace’ and fostering ‘excellence by example’. Assess the overall employer focused team with clinical leadership, including ongoing recruitment and hiring of talent. Ensure that the organization has the ‘right people’ in the ‘right positions’ and that the organization’s structure is designed to maximize results.
• Nurture personal and professional growth/development by attending seminars, workshops, and establishing professional affiliations to keep abreast of latest trends in field of expertise.
• Serve as an integral part in the design and implementation of medical management initiatives such as disease management to improve quality and cost effectiveness of care delivered to Commercial members.
• Swiftly respond to challenges and/or opportunities as they arise. Develop and implement innovative programs to act on historical data, identifying new trends, retooling existing approaches, and analyzing the competition.