UPMC Senior Communities

Role Description The UPMC Health Plan is seeking a Health Economics Analyst to lead the analysis of financial and clinical data to identify variation, inform strategy, and drive improved performance across UPMC Health Plan products and programs. This role will be focused on provider analytics, leveraging episode-based methodologies to compare cost, efficiency, and quality across providers. The Health Economics Analyst Lead will develop deep expertise in analytical tools and outputs, translate insights into actionable opportunities, and communicate effectively to internal and external stakeholders. Success in this role requires strong analytical judgment, intellectual curiosity to explore and identify potential use cases, and the ability to influence decision-making and drive measurable improvement. - Become increasingly familiar with basic medical claims terminology to interpret the impact of care delivery and finance on Health Plan performance. - Independently prioritize and manage up to 5 advanced quantitative and/or statistical analytics projects simultaneously with minimal supervision. - Produce customer-oriented reports that provide business context for the analysis and recommendations, requiring only moderate revision. - Routinely apply advanced data extraction and manipulation skills, complex analysis methods, statistical analysis, and data visualization tools. - Independently or in teams, produce a combination of quantitative financial analysis and clinical utilization analysis to generate insights into Health Plan performance. - Demonstrate attention to detail and initiative in discovering errors in data or analyses, or determining the need for additional follow-up analysis. - Develop knowledge and expert understanding of all products and benefit designs of UPMC Health Plan insurance offerings across all lines of business. - Maintain professionalism and a team-player attitude in a fluid, dynamic, fast-paced environment with ambiguity in priorities. - Consistently demonstrate a strong customer orientation, producing analyses on-time and communicating results effectively. Qualifications - Bachelor's degree in business, mathematics, statistics, health care management, decision sciences, or a similar quantitative field. Master's degree preferred. - Prior experience with financial and/or clinical modeling or data analysis is required. - Minimum of four-to-six years of work experience in a quantitative job function; seven years preferred. - Demonstrated prior application of analytics methods specifically to health insurance or health care delivery industry data at the senior analyst level. - Demonstrated expertise in particularly relevant analytical methods or health care business domain (payer/provider) may reduce time-in-position requirements. - Ability to apply analytical and statistical software tools to produce complex, quantitative analyses of the health insurance industry. - Experience with statistical analyses, predictive models, or dynamic business models. - Strong problem-solving skills in the creation and interpretation of quantitative analyses. - Ability to interpret and communicate results of complex, quantitative analysis to management and colleagues. - Ability to leverage leading-edge analytics experience from other industries to advance health care analytics. - General knowledge of business and economic principles strengthens the application. - Senior analyst-level experience using SQL, SAS, or R to conduct analysis is required. - Demonstrated application of similar programming languages or analysis tools such as SPSS, STATA, or C++ may also be acceptable. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description UPMC Health Plan and Workpartners is hiring a temporary Contact Center Navigator. This role will work Monday - Friday (Mondays and Friday standard daylight hours EST, Tuesday - Thursday 12 pm - 9 pm EST) and may work remotely. This role will not be eligible to work overtime. The budgeted hourly range for this position is $27.89-$35.00. The KnovaSolutions Contact Center Navigator is responsible for care coordination, health education and assessment for identified KnovaSolutions members through telephonic and other electronic collaboration with members. Collaborates with and facilitates coordination with KnovaSolutions nursing and pharmacy staff, other departments, providers, community resources and caregivers to provide additional support. Members will be followed by telephone or other electronic communication methods. The Contact Center Navigator is the first clinical contact for members identified as KnovaSolutions referrals. - Completes Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and Security Awareness. Preserves confidentiality of the member. - Utilizes independent problem solving and demonstrates ability to propose and implement creative solutions to member problems in order to achieve a high level of member satisfaction with KnovaSolutions. - Completes timely and accurate documentation of member contacts in the SMA health record. - Identifies health behaviors, risk factors or other concerns that would potentially improve members health if enrolled in the service. - Initiates outbound contact and responds to inbound contact with identified members to facilitate enrollment in KnovaSolutions. - Refers members to Company Benefits. - The Contact Center Navigator provides clinical triage of members to KnovaSolutions Clinical Prevention Specialists. Conducts initial health assessments using motivational interviewing techniques or other behavioral change skills. Qualifications - Bachelor's degree in behavioral, social work, nursing, public health or a related field strongly preferred - 2 years of experience in counseling, clinical assessment, care coordination, coaching, and/or care management strongly preferred - Active RN licensure strongly preferred - Bilingual in Spanish is a bonus - Knowledge of or ability to learn a family-centered counseling approach that emphasizes nonjudgmental empathic interaction and collaborative development and implementation of behavior change plans - Basic knowledge of workplace benefits, insurance reimbursement and EOBs - Detail-oriented individual with excellent organizational skills - High level of oral communication skills - Competently employ motivational strategies for encouraging individuals to explore motivation for change and enhance readiness - Intermediate proficiency with MS Word and Outlook - Ability to learn new computer-based documentation skills - Excellent verbal and written communication and interpersonal skills required Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran

Role Description Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. To continue our tradition of excellence, we are in search of a full-time Actuary to join this community. UPMC Health Plan is seeking an Actuary in its Department of Health Economics. This credentialed healthcare actuary would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies. Responsibilities include: - Lead the development of detailed actuarial and financial models to communicate near and long-term projections of financial performance of new and ongoing initiatives and clinical programs. - Analyze impacts of healthcare affordability initiatives on medical cost and utilization trends. - Apply analytical and statistical software tools to summarize large healthcare data to glean findings and actionable insights. - Incorporate healthcare claims cost and utilization trends into the development of projections used to define savings methodologies for affordability initiatives and programs. - Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions. - Guide the development of well-documented standard actuarial reports and projects. - Present results of analyses and recommendations to management and senior leaders. - Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations. - Creatively leverage a wide range of datasets to inform key analyses. - Provide direction and supervision to less experienced staff in the performance of duties. - Build strong relationships within cross-functional workgroups including Clinical, Pharmacy, Network, Actuarial, Analytics, and Finance teams across the enterprise. - Ensure that departmental work products meet the highest standards of quality. - Provide analytical support for ad hoc data analyses. Qualifications - Bachelor's degree in mathematics, statistics, actuarial science, economics or related field. - ASA or FSA certification. - 5+ years of experience in actuarial work in a health insurance, managed care or related consulting business; or equivalent training, education and/or experience. - Experience in evaluation of medical cost and utilization savings initiatives; statistical techniques for the evaluation of clinical programs; trend analysis; population health; utilization management (UM) / care management (CM) / disease management (DM) analysis is a strong preference. - Experience with commercial and government health programs is preferred. - In-depth understanding of health insurance market dynamics. - Excellent problem-solving and analytical skills. - Excellent oral and written communication skills. - Adaptability and ability to prioritize effectively. - Strong PC skills. - Data retrieval skills and relational database experience are required, including SQL and/or SAS. - Data visualization experience is preferred. Requirements - A.S.A. or F.S.A. certification by Society of Actuaries. - Membership in the American Academy of Actuaries. Benefits - Support for professional designations through our comprehensive student program. - Continuing education opportunities. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.