Job Description

Job Title: Health Management Specialist
Job ID: 180000SZ
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: HCMS0 - Clinical
Location: , Work From Home Work From Home

Description

WorkPartners HCMS Group is hiring a full-time Health Management Specialist to help support the Clinical department. This position will work remotely and is a Monday through Friday daylight position.

This position implements health management programs. Ensures successful implementation time frames.

Responsibilities:
  • Provide customer service health management customers (members, providers, internal department, government agencies, and/or accrediting bodies).
  • Contact health management members:
  • Assess member's physical, emotional, and psychosocial or other needs.
  • Assess the knowledge of the member regarding their disease and the need for education.
  • Identify barriers to care (transportation/prescription needs).
  • Contact providers to obtain information treatment and plan of care.
  • Document information obtained in the database according to department standards.
  • Follow up plans determined by triage script scoring.
  • Identify trends when opportunities for improvement are noted, based on information obtained from interaction with members and providers.
  • Assist in developing work plans and procedures or workflow-related opportunities identified for improvement.
  • Monitor the implementation of an action plan and provide feedback.
  • Provide reports on health management activities as requested.
  • Assist in the development and review of education/training materials for members and network providers.
  • Participate in education/training programs as requested.
  • Attend and participate in departmental meetings.
  • As requested by management, participate in other UPMC Health Plan and external meetings related to the functions/activities of the department.

Qualifications

  • Completion of an accredited School of Nursing.
  • Bachelor's degree in Nursing preferred.
  • 3 years of professional clinical experience required.
  • Experience in utilization management, home care, discharge planning and case management preferred.
  • Excellent communication skills, oral and written.
  • Must have computer skills.
  • Experience with Word, Excel, Access and E-mail required.

    Licensure, Certifications, and Clearances:
    RN license in other states as assigned

  • Registered Nurse

Salary Range: $26.64 to $44.88

Union Position: No

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