Job Description

Job Title: Health Manager (LSW, LCSW, RN) - Health Plan
Job ID: 681496
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Medical Mgmt SNP
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you a licensed health/human services professional with at least five years of experience in a clinical environment, care coordination, and/or case management? Do you have experience working in a managed care environment? If so, UPMC Health Plan may have the perfect fit for you!

 

 

UPMC Health Plan is currently hiring a full-time Health Manager to support Care Management processes for the Medicare Special Needs Plan (SNP).  This is a daylight position located in downtown Pittsburgh, offering the flexibility of 10-hour work days and work-from-home privileges after successful completion of on-site orientation (privilege eligibility is subject to continued achievement of business goals).   

 

 

UPMC Telephonic Special Needs Plan Health Managers perform the primary function of engaging SNP members for assessment of medical, functional, cognitive, psychosocial and behavioral health needs to facilitate the development and implementation of comprehensive individualized care plans.  Engagement with members occurs as the result of new enrollment in a SNP plan, changes in health status, transitions between health care settings, preventive gaps in care, psychosocial barriers, supplemental benefit administration, resource management, and other complex needs.  Health Managers also function as customer service agents for an inbound call center and must be prepared to manage requests for assistance that span the continuum of care, regardless of physical or behavioral origin.  

 

 

Responsibilities:

  • Perform inbound and outbound call center functions.  Make outbound calls to assigned members, as well as receive inbound calls from members, providers, community partners, and other health plan employees seeking Care Management assistance or intervention.   

  • Conduct Health Risk Assessments (HRAs) to identify members’ medical, functional, cognitive, psychosocial and behavioral health needs.

  • Conduct Transition of Care (TOC) assessments when members move between health care settings to identify transitional needs.

  • Perform clinical reviews of medication adherence, secondary and tertiary utilization, and gaps in preventive health care.

  • Engage members to develop Individualized Care Plans (ICPs) in collaboration with their Interdisciplinary Care Teams (ICTs) that focus on self-management goals, personal health care preferences, and the provision of services specifically tailored to meet their unique needs.

  • Facilitate achievement of ICP goals by leveraging health coaching, and resource and care coordination strategies to promote a healthy lifestyle, close gaps in care, and reduce unnecessary ER utilization and hospital readmissions.

  • Modify ICPs as the members’ health care needs change and communicate revised plans to the members’ ICTs. 

  • Refer to appropriate health management, lifestyle or behavioral health special programs based upon members’ needs or request.

  • Collaborate with Community Health Choices (CHC) Care Managers and Long-Term Services and Support (LTSS) Service Coordinators to facilitate accessibility of services for SNP members. 

  • Provide concierge-level service by scheduling appointments, communicating with providers, and ensuring members have access to important supplemental benefits. 

  • Attend, and participate in, monthly ICT meetings to offer feedback and recommendations to peers, providers and community partners requesting review of medically complex member cases. 

  • Prepare case summaries for medically complex members and present for clinical review by the Interdisciplinary Care Team at formalized monthly ICT meetings.

  • Perform duties and responsibilities in accordance with the philosophy, values, and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with health plan members, providers, coworkers and external contacts.

  • Comply with federal regulatory requirements and UPMC policy and procedure for documentation of care management activities for Medicare Special Needs Plan members. 

Qualifications

  • Masters degree in human service field plus licensure required or Licensed Pennsylvania RN with 6-8 years clinical experience required Bachelors degree in nursing preferred.
  • Five years of experience in a clinical environment, care coordination, and/or case management required.
  • Three years of experience in a managed care environment preferred.
  • General knowledge of best practices with special needs populations and in provider systems
  • Ability to interact with physicians and other health care professionals in a professional manner required.
  • Computer proficiency required.
  • Experience with Excel and Access databases preferred.
  • Excellent verbal and written communication and interpersonal skills required.
  • Knowledge of community resources required

Licensure, Certifications, and Clearances:
Case Manager certification preferred Licensure in other states as assigned

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

Salary Range: $22.60 to $39.11

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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