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UPMC Telephonic Care Manager (RN) - Diease Management in Pittsburgh, Pennsylvania

Description

Are you an experienced nurse with an interest in the world of case management? Do you thrive on working in a professional environment? We are looking for you! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support our Health Management department's Medicaid line of business.

This position will work standard daylight hours, Monday through Friday with occasional Saturday and evening coverage.

The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. In this role, you will identify members' medical, behavioral, and social needs and barriers to care. You will develop a comprehensive care plan that assists members to close gaps in preventive care, address barriers to care, and support the member's self-management of chronic illness based on clinical standards of care. You will actively collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Our Members are followed by telephone or other electronic communication methods.

Responsibilities

  • Present complex members for review 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.

  • Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.

  • Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate.

  • Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.

  • 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.

  • 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. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.

  • 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.

  • Conduct member outreach in response to requests from employer groups, community and/or governmental agencies to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.

Qualifications

  • Minimum of 2 years of experience in a clinical and/or case management nursing required.

  • BSN preferred.

  • Case management experience highly preferred.

  • Ability to interact with physicians and other health care professionals in a professional manner required.

  • Excellent verbal and written communication and interpersonal skills required.

  • Computer proficiency required.

Licensure, Certifications, and Clearances:

  • Case management certification or approved clinical certification preferred

  • Registered Nurse (RN)

UPMC is an Equal Opportunity Employer/Disability/Veteran

REQNUMBER: 66369787

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