Job Description

Job Title: Nurse Liaison (RN) - Case Management
Job ID: 683302
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Cancer Centers
Department: Hillman HBC
Location: 5115 Centre Avenue, Pittsburgh PA 15232

Description

Are you an experienced nurse with a background in managed care or utilization review? Are you looking to make a difference in the care of oncology patients? We are looking for you!

UPMC CancerCenter is hiring a full-time Nurse Liaison (RN) to help support our Medical Oncology division for our UPMC Hillman CancerCenter, located in the Shadyside neighborhood in the city of Pittsburgh, PA. This position will work a regular Monday through Friday daylight schedule.

Initiates the clinical management effort in coordination with multi-disciplines in order to effectively influence attainment of desired clinical outcomes. Promotes a collaborative healthcare intake process and facilitates proper allocation of resources. Serves as functional team leader to Pre-Arrival and Scheduling Representatives.

Responsibilities:
  • Actively live and demonstrate University of Pittsburgh Medical Center Health System core values.
  • Adapt quickly to changing conditions, assimilating new processes into job functions and taking ownership.
  • Assist in the design and implementation of a program that elicits desired outcomes on an organizational level.
  • Communicate and work with physicians, physician office personnel, associates, case managers, third party payer review personnel, and others in order to expedite the intake/utilization review process to avoid negative financial impact on the facility.
  • Demonstrate patient assessment skills and knowledge of patient acuity levels.
  • Display dynamic communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers.
  • Display effective time management and organizational skills to identify, prioritize and reach goals and objectives faster and easier, cope with multiple demands in a timely manner, and overcome changing priorities.
  • Effective critical thinking, problem solving and decision making skills.
  • Handle a high degree of pressure, heavy workloads, multiple requests, numerous interruptions, and short deadlines in a positive manner, establishing priorities for effective work completion.
  • Interpret complex medical data to analyze applicability of review criteria to ensure optimal patient care while maximizing reimbursement.
  • Interpret insurance contract guidelines and expectations and make recommendations for compliance.
  • Interpret third party payor contract requirements and recommend, design and implement procedures for compliance with regulations and standards.
  • Maintain creativity in making process recommendations.
  • Maintain knowledge of SI/IS criteria for commercial, Medicare, and Medicaid insurance products.
  • Maintain strict confidentiality within and outside the organization.
  • Negotiate with insurance vendors, medical directors, and third party payors when appropriate in order to facilitate the delivery of care in the most appropriate setting.
  • Possess self-motivated spirit and seek educational opportunities to increase professional competency.
  • Serve as a change agent, coach, mentor, team builder and facilitator.
  • Serve as a role model to others.
  • Successfully plan, monitor, support and improve multiple activities.
  • Use knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.

Qualifications

  • Bachelors Degree from an accredited school of nursing/allied health preferred. 
  • 3-5 years of progressive nursing in an acute care setting with at least one year of experience in utilization review or managed care required.
  • Experience performing scan authorizations, medication authorizations and reviewing medication scheduling, strongly preferred
  • Extensive knowledge of clinical symptomology and related treatment required. 
  • Knowledge of insurance policies
  • Proficient computer skills, knowledge of Microsoft Office
  • Knowledge of 3rd party payer review criteria
  • Patient assessment skills and knowledge of patient acuity levels
  • Previous oncology experience a plus but not required

Licensure, Certifications, and Clearances:
  • CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
  • Act 34 Criminal Clearance
  • Registered Nurse
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $26.64 to $44.88

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!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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