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Reporting to the CMO of The Insurance Services Division (ISD), the AVP Physician Performance and Network is the accountable and responsible physician executive to co-lead provider performance and engagement (PPE) operations, along with responsible leadership from Network/VBP (Value-Based Payment) and Care Management. The role focuses on design, strategy, operations, and delivery of provider VBP programs, actionable reports, education, and engagement to support total cost of care management and ensure members receive care focused on quality and population health. The position is an executive leader within the Population Health (Clinical) organization contributing to care management, utilization management, quality, and pharmacy services of the UPMC Insurance Services Division, especially at the intersection of how providers and VBP programs can support these clinical areas. An important requirement of the new AVP Physician Performance and Network is experience broadly across health plan environments and provider practice with strong working knowledge and perspective on how value-based care models and value-based payment strategies support performance, effectiveness, and the satisfaction of providers and their productive interactions with patients/members. An additional competency is delivering an experienced strategy for provider engagement operating model design to deliver actionable reports, interactions, and outreach to providers. The ideal candidate has experience leading the development of new models, methods, and innovations to enhance health outcomes.

This key physician leader will also directly engage with network provider clinical leadership (providers, hospitals, practices and related networks) to deliver, listen, and respond to VBP operations.

Responsibilities:

+ Key leader, decision maker, and catalyst for overall strategic development and operations of provider performance and engagement (PPE) to achieve the Quadruple Aim and UPMC’s targets for VBPs related to cost and utilization

+ Be a strategic, collaborative business partner for clinical support of the strategy and operations of UPMC Health Plan's network strategies, especially providing leadership to the development of clinical performance standards related to VBPs and other clinical programs that are based in provider collaboration.

+ Develop relationships with key providers, group practice, and hospital leadership throughout the health plan network. Ensure feedback of PPE is heard and used to adjust and advance VBP model design and delivery.

+ Develop an understanding of the healthcare landscape, unique health needs and attributes of the populations served, and provider network to look for key drivers and opportunities for innovative care delivery models and drive development of VBP and payment models

+ Leadership, direction, and oversight for staffing, processes, technology, and operations for provider performance and monitor and adjust based on performance and engagement outcomes.

+ Work closely with Senior and Executive leadership in developing appropriate network strategies specific to each line of business

+ Working collaboratively with the health plan's Medical Directors, product leads, and business leadership in achieving cost of care targets and mitigate trends through PPE.

+ Adhere to and exemplify the leadership values and behaviors of UPMC for staff to model

+ M.D. or D.O. license required.

+ Minimum of 5 years of clinical practice.

+ Minimum of 7-10 years of provider leadership experience.

+ Experience with value-based payment/care programs.

Licensure, Certifications, and Clearances:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

UPMC is an Equal Opportunity Employer/Disability/Veteran