COVID-19 Vaccination Information

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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   Current UPMC employees must apply in HR Direct

Professional Care Manager

  • Job ID: 797460751
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Variable
  • Facility: UPMC Western Maryland
  • Department: Care Coordinat
  • Location: 12500 Willowbrook Rd, Cumberland MD 21502
  • Union Position: No
  • Salary Range: $25.54 to $43.74 / hour

Description

Are you an experienced Nurse looking to take the next step in your career? The Care Coordination department at UPMC Western Maryland has the right fit for you! During the interview, you’ll learn about what schedules and areas of coverage the department has to offer.  

 This position will cover our Emergency Department and will work varied shifts with rotating weekends and holidays.

This position is eligible for a generous sign-on bonus!

If you are an experienced nurse looking to join UPMC, apply now!
Sign-On Bonus Details:
 $6,000 with a 2-year work commitment.

As a Care Manager (CM), you will coordinate the clinical and financial plan for patients. You will perform overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations. You will work with a multi-disciplinary team in resource management, discharge planning and care facilitation.

Responsibilities:

  • Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
  • Collaborates with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.
  • Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care.
  • Documents Freedom of Choice re: post-acute services.
  • Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
  • Attends Department meetings and Corporate Care Management Training sessions to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources.
  • Ensures compliance with all payer and government regulations.
  • Promotes patient safety.
  • Supports CORE measures information for JCAHO requirements.
  • Takes leadership role in concurrent denial process.
  • Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC.
  • Initiates acceptance of lower LOC when appropriate with assistance from billing office.
  • Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.
  • Starts discharge planning on admission and ensures DC documentation is completed and updated regularly.
  • Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge.
  • Addresses complex clinical and social situations efficiently to avoid unnecessary delays in discharge.
  • Documents all Avoidable Days in CANOPY system.
  • Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.)
  • Obtains all necessary authorizations for level of care including admission and continued stay.
  • Follows payer-specific requirements to obtain and document authorizations.

 

Qualifications

Qualifications

  • Graduate of approved school of nursing.
  • Two (2) years of nursing experience required.
  • BSN or related bachelor’s degree preferred.
  • Previous case management experience preferred.
  • Knowledge of healthcare financial and payor issues preferred.
  • Knowledge of state, local, and federal programs preferred.
  • Use of InterQual criteria preferred.

Licensure, Certifications, and Clearances:

  • Current licensure as a Registered Professional Nurse either in the state where the facility is located or in a state covered by a licensure compact agreement with the state where the facility is located.
  • UPMC approved Care Management certification preferred

 

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Security Alert

We are aware of scams targeting UPMC and other large companies that involve individuals posing as employees to illegitimately conduct interviews and extend false employment offers and payments to gain access to candidates' personal information. Please note that UPMC will not communicate with candidates through third-party email services like Gmail or Yahoo. While some interviews may take place via a video conferencing service, UPMC Talent Acquisition will not conduct interviews via Skype or Google Hangouts. UPMC will never ask for or disburse funds during the recruitment process. If you are hired into a role with a sign-on bonus or similar incentive, funds will be paid to you by UPMC after your start date.

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