VP, Community and Home-Based Services in Pittsburgh, Pennsylvania

The Vice President, Community and Home-Based Services has responsibility for ensuring quality care and appropriate services are provided to health plan members experiencing continuing care services and post-hospital care. In addition, this position, in partnership with several leaders across the regions is responsible to develop and implement a future vision for care across the continuum and creating systematic opportunities to continue to develop and lead as a community and home-based health system. This position deploys measurement systems, operational processes, goals and investments to effectively improve the performance of the region. This position will provide regional oversight and monitoring of the planning and implementation of continuum and community and home-based capacity management and strategic resource planning.

Responsibilities:

• Provide executive level leadership, strategic direction and recommendations over areas of accountability.

• Identify and implement actions in areas of accountability to improve quality, service, financial performance and contractual compliance.

• Implements the optimal structure and processes to assure success of all areas related to the home and community-based continuum of care.

• Directs other activities as assigned that improve care to our members and the communities we serve as well as management of the community-based teams.

• Ensuring that our company is positioned to maintain ongoing regulatory compliance across the continuum of care, including NCQA accreditation, Medicare Star high performance, CDPH and CMS care delivery compliance.

• Champions new ways of meeting organizational goals including the development of internal and external capabilities and new models of care.

• Explores critical issues related to post-acute care and care for specific population and designs responsive solutions.

• In partnership with key stakeholders, developing and implementing the future vision for care across the home and community-based continuum enhancing our value as a community health system.

• Coordinate activity of a variety of Health Services Division community and ambulatory services and Health Plan committees including, but not limited to, PSD, HSD, Hospital leadership teams. Interface with executive leadership across the UPMC to advance goals of the enterprise.

• Serve as the departmental representative to the various committees as per leadership.

• Establish and implement a patient-centered care coordination and advocacy process which embraces clinical quality, patient and provider satisfaction, and cost sensitivity while ensuring a competitive edge in the region.

• Implement, monitor and evaluate all quality initiatives to ensure positive patient outcomes. Oversee quality and efficiency of all program operations.

• Ensure compliance with UPMC policies and procedures and with the requirements of any applicable regulatory agencies or accrediting bodies (i.e., JCAHO, PA DoH, Medicaid).

• Develop strategies to maximize reimbursement and disseminate regulatory information pertaining to changes in reimbursement and/or coding while ensuring regulatory compliance.

• Create and implement business and program development plans that support and advance Home and Community Based Services and Health Plan strategic initiatives.? Marketplace Evaluation: Review, evaluate and provide recommendations regarding all like competing entities entering or in the market, whether payor, provider, or private equity/venture capital based.

• This position will report directly to the Sr. VP & Chief Clinical Administrative Officer. In addition, this position will work directly with the President of Home Health and Hospice Services.

• The position will work closely with network medical and clinical leadership and other regional leaders to resolve issues related to Health Plan post-acute care and hospital clinical support services.

• Models and reinforces the UPMC Values and the ISD PRIIDES values, including ethical behavior in self and others in accordance to the Principles of responsibility; adheres to organizational policies and guidelines, supports compliance initiatives, maintains confidences, admits mistakes, conducts business with honesty, shows consistency in words and actions, and follows through on commitments.

• As a leader, the position is accountable for communication, implementation, enforcement, monitoring, and oversight of compliance policies and practices in their departments.

• Create a culture within the community service line which is decisive, creative and action oriented

• Oversee and assure integrity of and high- quality delivery of services across all operationswithin community services

• Represent community services perspectives to Executive Leadership

• Administer, direct and coordinate all areas within community services to assure high levels of quality, service and compliance throughout the operation

• Achieve or exceed all performance expectations

• Manage operating and capital budgets within broad area of responsibility

• A Bachelor’s degree and Master’s degree in a health care, business or related field or comparable work experience is required.

• Minimum of 15 years of progressively responsible operational and financial management roles, culminating in at least five years in a top general management role in a complex, execution-oriented healthcare company; a demonstrated ability to produce excellent quality outcomes and member satisfaction.

• A strong and detailed view for developing next-generation community and member engagement models and service innovations and successful partnership with the prehospital and community-based service providers.

• Competent knowledge and ability in financial analysis, reimbursement practices and contract negotiation skills are essential.

• Excellent interpersonal communications, verbal and written skills are required.

• Track record of strong clinical utilization & care program management, general management, supervisory, team building and leadership skills; excellent writing and communication abilities; direct clinical experience in multiple settings & levels of care, including both mental health & substance abuse. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran