Job Description

Job Title: Clinical Case Manager (RN) - WorkPartners
Job ID: 706637
Status: Full-Time
Regular/Temporary: Regular
Hours: Monday-Friday, daylight hours
Shift: Day Job
Facility: UPMC Health Plan
Department: External Leave Mgmt
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
This position will perform clinical case management activities for WorkPartners Disability Claims Unit as assigned. Additionally, act as a liaison between each UPMC entity and WorkPartners in the development and daily administration of this program.

Responsibilities:
  • Acts as a medical resource person for staff; provides educational opportunities for staff through training, in-service, and sharing of resources on one-on-one or group forums, whichever is most efficient and effective.
  • Assess recommended frequency and duration for intermittent leaves, made by health care providers. Provide input to specialists and/or contact providers to obtain clarity or additional information.
  • Assists case management staff in making decisions regarding client's physical abilities as a result of the medical condition.
  • Collaborates with health care providers and ill/injured employees to update the status of treatment plan and length of disability.
  • Completes all case activity in claim notes.
  • Discussion of disability claims with claim managers to assist with understanding the medical documentation received.
  • Facilitates return-to-work (RTW) efforts through negotiation with client, treatment provider and employee.
  • Frequent communication telephonically, via email, and instant messaging to internal business partners.
  • May need to call out to customers and health care practitioners to obtain clarity or additional information to complete the file.
  • Monitor employee's care and progress during an injury or illness by reviewing medical documentation from employee and/or employee's treating provider to document the employee's continued absence and maintain updated medical records.
  • Provide insight to leave professionals regarding intermittent absence guidelines for common medical conditions to support frequency and duration reviews.
  • Review medical documentation submitted on behalf of the employee, by the provider to evaluate the employees level of incapacity in conjunction with disability duration guideline and job demands.

Qualifications

  • Registered Nurse (RN) with current Pennsylvania licensure. 
  • BSN preferred (equivalent professional and educational experience will be considered). 
  • Minimum of two (2) years experience in a clinical and/or case management nursing role required. 
  • Ability to interact with physicians and other health care professionals in a professional manner required. 
  • Previous disability case management experience is preferred. 
  • Knowledge of Employee Retirement Income Security Act of 1974 (ERISA) preferred.
  • Knowledge of client leave policies, federal and state leave laws pertaining to leave of absence preferred. 
  • Excellent verbal and written communication and interpersonal skills required.  
  • Excellent organizational and communication skills required. 
  • Computer skills/literacy a must. 
  • Ability to work independently and with various departments/personnel while managing the case.

Licensure, Certifications, and Clearances:
  • Registered Nurse

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

Salary Range: $26.64 to $44.88

Union Position: No

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