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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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Supervisor, Health Manager- Medical Management

  • Job ID: 813449296
  • 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: $29.18 to $49.16 / hour

Description

UPMC Health Plan is hiring a full-time Supervisor Health Manager to support the Medical Management Medicaid team. This position will work standard daylight hours, Monday through Friday. The team is based out of downtown Pittsburgh's US Steel Tower and this role will work in a hybrid structure. 

The Supervisor, Health Manager is the point person for all behavioral health coaching staff and ensures continuity and coordination of care for Health Plan members with behavioral health illnesses and complex behavioral health needs. The Supervisor, Health Manager is responsible for the day to day oversight of case assignment and complex issues that arise in the call center as well as supervision of the behavioral health coaches.

Responsibilities:

 

  • Assumes responsibility for health plan member's access to in-plan and/or supplemental services as medically indicated.
  • Provide reports on case management cases or activities as requested.
  • Supervise collection of information from members and health coaching staff concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures which improve the flow of services to members.
  • Assists in the development and revisions of programs, policies, and procedures.
  • Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
  • Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and network providers.
  • 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.
  • Oversee performance of health managers and works with direct supervisor for administrative and clinical issues.
  • Preserve confidentiality of the member.
  • 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.
  • Performs clinical reviews, service authorization and care coordination and oversight and supervision of other team members for all Health Plan members receiving services.
  • Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues.
  • Serves as a resource to staff and other Health Plan departments to identify opportunities for improvements, quality of care concerns, barriers and root causes, and participates in the member complaint and grievance process.
  • Receives and responds to complex calls regarding requests for services or resolution of complex issues.
  • 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.
  • 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.
  • Supervises behavioral health staff, which includes, but is not limited to: Monitors, coaches, and reports staff activity/productivity on a weekly, monthly, and quarterly basis Monitors and assists staff in problem-solving and managing case referrals and work flows Assists staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas Evaluates staff performance on an ongoing basis, completes timely EPRs, and initiates corrective action, as appropriate
  • Ensure adequate staff coverage and phone coverage for all shifts as well as transition to afterhours clinical care.

 

Qualifications

  • Master's degree in nursing, social work, counseling, psychology or human service field
  • Five years of experience in behavioral health clinical, care coordination, and/or case management required.
  • Three years of experience in a managed care environment preferred.
  • Pediatric experience preferred
  • Case management experience preferred
  • Prior supervisor experience preferred
  • General knowledge of best practices in behavioral health, emphasizing work with special needs populations and in provider systems
  • 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:

  • Clinical Licensure or RN Licensure
  • Case Manager certification preferred
  • Clinical Social Worker (CSW) OR Licensed Social Worker (LSW)

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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