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Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Health Care Manager - OB/Maternity

  • Job ID: 546857545
  • 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
  • Union Position: No
  • Salary Range: $24.78 to $42.84 / hour

Description

UPMC Health Plan is hiring a full-time Health Manager to support the Medical Management Medicaid department. This role will predominantly work Monday through Friday during standard daylight hours. Preference will be given to candidates that are bilingual with previous OB and home visiting experience. This role will work remotely and preference will be given to candidates located in Eastern Pennsylvania. 

The Health Manager ensures continuity and coordination of care for Health Plan members with chronic conditions and complex health needs.

Responsibilities:

 

  • Provides members, providers, and other stakeholders with information concerning benefits and coverage, and provides accurate information to members and families.
  • Monitors and evaluates effectiveness and outcome of treatment plans, restructures as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care and maximal use of community supports and resources.
  • Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
  • Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues.
  • Preserve confidentiality of the member.
  • Develop and coordinate an individualized treatment plan with the member, member's family, and providers.
  • Evaluate the effectiveness of the treatment plan and identify gaps in service. Make recommendations for changes when indicated.
  • Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and network providers.
  • Independent problem solving based on sophisticated knowledge of in-plan services, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization.
  • Follow-up with the member according to established timeframes to monitor their care to assess whether quality care is being provided in an appropriate setting.
  • Perform duties and responsibilities in accordance with the philosophy and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
  • Identifies provider issues and recommendations for improvement.
  • Contact potential case management members to determine if there is a need for case management intervention.
  • Receives and responds to complex calls regarding requests for services or resolution of complex issues.
  • Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
  • Performs clinical reviews, service authorization and care coordination (or oversight and supervision) for all Health Plan members receiving services.
  • Complete Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and Security Awareness.
  • Provide reports on case management cases or activities as requested.
  • Perform in accordance with system-wide competencies/behaviors.
  • Appropriate documentation in the care management documentation system including assessments, problems, goals and interventions.
  • Assumes responsibility for health plan member's access to in-plan and/or supplemental services as medically indicated
  • Interfaces with and refers members to community based resources and other supportive services as appropriate.
  • Maintains an understanding of behavioral health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and behavioral health management policies and procedures.
  • Participate in integrated care team meetings in a cross cultural environment to coordinate transitions of care, discharge planning, benefit coverage, conflict resolution and resource needs.
  • Conduct comprehensive assessment of needs and coordination of care activities for individuals with primary diagnosis of alcohol or substance use addiction

 

Qualifications

  • Master's degree in human service field plus licensure required OR Licensed Pennsylvania RN with 6-8 years clinical experience required. Bachelor's degree in nursing preferred.
  • Five years of experience in clinical, care coordination, and/or case management required.
  • OB/Maternity experience preferred. 
  • Three years of experience in a managed care environment preferred.
  • General knowledge of best practices in health care, emphasizing work 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 Microsoft office products preferred.
  • Excellent verbal and written communication and interpersonal skills required.
  • Knowledge of community resources required.


Licensure, Certifications, and Clearances:

  • Registered Nurse (RN) OR Social Services Licensure (LSW, LCSW, LPC)
  • Licensure in other states as assigned
  • Case management certification or approved clinical certification preferred



UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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