Senior Director, Commercial Compliance

/Senior Director, Commercial Compliance
Organization: UPMC Health Plan (UPMC HP)
City: Pittsburgh
State: PA
Country: USA
Description:

Witt/Kieffer is assisting UPMC Health Plan (UPMC HP) based in Pittsburgh, Pennsylvania in recruiting its new Senior Director, Commercial Compliance (Senior Director).

The Senior Director, who is responsible for building a new department, will strategically and operationally lead the development, implementation and management of a robust and effective Commercial Compliance Program for UPMC’s large and growing Insurance Services Division. This position strategically ensures compliance with all relevant and applicable laws, regulations, and contractual agreements in a manner that continually supports the business and operational areas. In addition, this position oversees the workers’ compensation and ancillary/third-party administrator (TPA) compliance programs and functions.

Reporting to the Senior Vice President, Chief Risk, Compliance & Ethics Officer, the Senior Director will provide overall direction through the strategic development and execution of a healthcare compliance program in support of the mission and strategic goals of UPMC Health Plan. This is an exciting opportunity to join a health plan that is among the fastest-growing in the nation and work closely with senior leadership in realizing its overall goals and objectives.

UPMC HP is part of the larger and diversified UPMC Insurance Services set of partner and affiliated companies, which itself is part of the broader UPMC Health System, a world-renowned integrated health care delivery and finance system. As part of an integrated health care delivery system, UPMC Insurance Services and Health Plan are committed to providing their members with access to high-quality and affordable health care. UPMC Health Plan partners with UPMC and non-UPMC network providers to deliver a combination of knowledge and expertise that provides the highest quality care at the most affordable price. Formed in 1996, UPMC HP now serves approximately 3.5 million members. The UPMC Insurance Services Division offers a full range of group health insurance, commercial, Exchange, Medicaid, Medicare, Special Needs, CHIP, behavioral health, employee assistance, ancillary and specialty, and workers’ compensation products and services.  UPMC HP’s local provider network includes UPMC as well as non-UPMC community providers, totaling more than 140 hospitals and more than 23,300 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland. UPMC HP’s 2018 annual revenue will be approximately $9.5 billion with 2019 projected revenues to be approximately $11 billion.

The successful candidate must have a Bachelor’s degree while a Master’s Degree and/or JD is preferred. In addition, candidates must have an outstanding record of achievement with at least eight years of health plan commercial compliance insurance experience. The successful candidate will also be a transparent and collaborative leader, comfortable spearheading and supporting change in a complex environment. Prior in-house legal or compliance experience; commercial compliance experience and workers’ compensation and/or ancillary/third-party administrator compliance experience are preferred.

Inquiries/questions/materials should be submitted via email to UPMCCommercialCompliance@wittkieffer.com.

 

Contact: UPMCCommercialCompliance@wittkieffer.com
Link to Apply: