University Of Pittsburgh Medical Center Sewickley , PA 15143
Job Title: Clinical Care Manager (RN) - Transition Coordinator at Heritage Valley Sewickley Hospital
Job ID: 695916
Shift: Day Job
Facility: UPMC Health Plan
Department: Pop Health Case Mngt
Location: , Sewickley PA
Do you have a strong interest in health insurance and care management? Are you interested in working onsite in a hospital setting, but want to work daylight hours? This opportunity may be a great fit for you! UPMC Health Plan is hiring a full-time Clinical Care Manager supporting our Medical Management group's onsite presence at Heritage Valley Sewickley Hospital
In this position, you will be employed through UPMC Health Plan, but will work onsite at Heritage Valley Sewickley and will function as a transition coordinator for UPMC Health Plan Members receiving care.
The position will work standard daylight hours, Monday through Friday.
The Clinical Care Manager is responsible for care coordination and health education with identified Health Plan members through face to face collaboration with members and their caregivers and providers. The Care Manager identifies members medical, behavioral, and social needs and barriers to care, and develops a comprehensive care plan that assists members to close gaps in preventive care. In this role, you will address barriers to care, and support the members self-management of chronic illness based on clinical standards of care. Additionally, you will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support.
UPMC Health Plan, headquartered in Pittsburgh, Pa., is among the nation's fastest-growing health plans. As part of an integrated health care delivery system, UPMC Health Plan is committed to providing its members better health, more financial security, and the peace of mind they deserve. UPMC Health Plan partners with UPMC and community network providers to produce a combination of knowledge and expertise that provides the highest quality care at the most affordable price. Our local provider network includes UPMC as well as community providers, totaling more than 125 hospitals and more than 11,500 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.
Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care.
Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.
Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
Document all activities in the Health Plan's care management tracking system following Health
Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.
Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in the Beating the Blues or other education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.
Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
Minimum of 2 years of experience in clinical and/or case management nursing required.
Minimum 1 year of health insurance experience required.
1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
Excellent organizational skills
High level of oral and written communication skills
Computer proficiency required
Licensure, Certifications, and Clearances:
Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role)
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
Act 33 Child Clearance with Renewal
Act 34 Criminal Clearance with Renewal
Act 73 FBI Clearance
Older Adult Protective Services Act
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities Salary Range: $28.37 to $47.88
Union Position: No
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