Job Description

Job Title: Manager, Pediatric Care Management (RN)
Job ID: 684571
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Medical Mgmt Medicaid
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you an experienced pediatric nurse with a strong background in the field of care management? Are you ready to take the next step in your care management career? UPMC Health Plan is hiring a manager to support their Pediatric Telephonic Care Manager team.

The Manager is responsible for the operational functions of a care, health, or utilization management team including the direct supervision, coaching and counseling of clinical staff. Collects and monitors reports related to staff performance; reviews performance against Health Plan goals and completes staff evaluations; and makes recommendations for improvement. Contributes to program evaluations for clinical initiatives that enhance member satisfaction, improve quality of care, and reduce cost. Represents the director upon request by servicing as a liaison to internal departments or government or employer based agencies.

Responsibilities:
  • Assists in the development and implementation of new or revised programs, policies or procedures. Monitor progress, develop recommendations for improvement, and monitor action plans to ensure the integrity of the programs are maintained and deadlines are met. Assist with integrating HP programs across the Health System and vendors as needed.
  • Conducts regularly scheduled team meetings to communicate key information, engage staff in daily operations, and provide ongoing staff education.
  • Consistently recognize staff contributions through performance evaluations and nomination for system and health plan staff recognition programs. Complete performance evaluations within departmental timeframes.
  • Ensure adherence to department guidelines related to orientation of staff and documentation of staff competency including compliance with government training requirements
  • Facilitate detailed case reviews with appropriate Health Plan team members including medical directors and other members of the interdisciplinary team to identify barriers to care and initiate appropriate team coordination. Assist staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas. As appropriate manage and assist with discharges or transfers to appropriate level of care.
  • Monitor, coach and report staff activity and productivity; Assist with analysis and monitoring of key financial and utilization targets and trends. Complete quality audits and team reports within departmental timeframes.
  • Provide staff with applicable regulatory guidelines related to their departmental expectations (I.E. NCQA, DPW, CMS). Consistently monitor and work with internal compliance departments to ensure adherence.
  • Supports supervisors with problem-solving and managing case referrals and work flows according to established program descriptions. Utilize evidence based practice to support improvement in care / health / utilization management.

Qualifications

  • Masters degree in nursing or related field required
  • Minimum of 2 years of pediatric nursing experience required
  • Minimum of 4 years of care manager experience required
  • 3 years of experience in a managed care environment preferred.
  • Prior management, supervisory, or leadership experience required. 
  • Case management certification or approved clinical certification required or 2 years health plan management experience required 
  • Ability to analyze data and identify trends 
  • Proficiency with Microsoft Office products 
  • Excellent interpersonal and communication skills (verbal and written)
  • Ability to collaborate effectively with physicians and other health care professionals 
  • Strong organizational and problem solving skills with ability to make decisions independently 
  • Ability to develop and maintain effective team-focused working environment

Licensure, Certifications, and Clearances:
  • Case management certification or approved clinical certification required or 2 years health plan management experience required
  • Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $33.94 to $57.47

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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