Senior Medical Director, Medicaid

Morgan Consulting Resources, Inc. - Healthcare Executive Search; Pittsburgh (Allegheny County); On-site; USD 250,000 - 350,000; Full time

Job summary

Senior Medical Director, Medicaid at UPMC for You reports to the CMO and leads medical strategy for a $5 billion Medicaid program with statewide reach in Pennsylvania.

The role combines clinical, operational, quality, and financial oversight to drive value-based care and performance Responsibilities include serving as the primary clinical liaison with DHS, ensuring regulatory compliance, developing quality programs, and partnering with Utilization Management, Care Management, Quality, and

Qualifications

• MD/DO required and Pennsylvania medical license.
• Board Certification in ABMS or equivalent.
• Post residency clinical experience required; 10+ years preferred.
• Clinical experience in historically underserved populations preferred.
• 10+ years of management experience preferred; experience in a managed care setting preferred.

Responsibilities

• Provide medical leadership for Medicaid product across clinical, operational, quality and financial performance.
• Ensure DHS contractual and regulatory obligations are met; liaise with DHS.
• Develop and execute strategies to improve quality and financial performance with value-based initiatives.
• Strengthen provider relationships and use data analytics to identify opportunities for improved outcomes.

Skills

MD/DO

PA license

Board Certification

Clinical leadership

Managed care experience

Education

MD/DO degree

PA medical license

ABMS Board Certification

10+ years clinical experience

Job description

Reporting to the Chief Medical Officer (CMO) of Government Products, the Senior Medical Director, Medicaid will provide medical leadership for UPMC for You and serve as the senior physician leader dedicated to the Medicaid product. This highly visible role has broad responsibility for the clinical, operational, quality, and financial performance of a $5 billion Medicaid business with a statewide presence. Working closely with the Medicaid product leadership, in highly matrixed environment, the Senior Medical Director will partner closely with leaders across Utilization Management, Care Management, Quality, Pharmacy, Provider Relations, Network, Finance, Operations, and other shared services to ensure the continued success of the Medicaid product.

A key responsibility of the position is ensuring that UPMC for You meets its contractual and regulatory obligations to the Pennsylvania Department of Human Services (DHS). The Senior Medical Director will serve as a primary clinical liaison with DHS and provide leadership across Quality Management, Utilization Management, Quality Improvement, credentialing, medical necessity, and other areas central to the effective operation of the plan. The position will also help develop and execute strategies to improve quality and financial performance, advance value-based and pay-for-performance initiatives, strengthen provider relationships, and use data and analytics to identify opportunities for improved outcomes and performance.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required
• Unrestricted Pennsylvania MD or DO license required
• Board Certification in ABMS American Board or Medical Specialists required
• Post residency clinical experience required; 10+ years of clinical experience preferred
• Clinical experience in historically underserved (including people with disability) populations preferred
• 10+ years of management experience preferred; experience in a managed care setting preferred
• Ability to implement medical policies and to enforce those policies through appropriate action
• Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional institutional providers of care
• Ability to implement programs of quality care analysis, peer review, and professional education