Description

Are you an experienced nurse with an extensive background in case management? UPMC Health Plan is looking for you! We are hiring a full-time mobile Clinical Care Manager to support the Home and Community-Based Services (HCBS) Command Team. The HCBS Command Team provides case management to Community HealthChoices full-risk members. Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth, as well as dual-eligible individuals covered by Medicare and Medicaid. 

The mobile Clinical Care Manager will visit members in the community setting in Allegheny County. 

As a Clinical Care Manager, you will be responsible for care coordination and health education with identified Health Plan members through face-to-face collaboration with members and their caregivers and providers. You will identify members' medical, behavioral, and social needs and barriers to care. You will then develop a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. You will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Title and salary will be determined based upon education and nursing experience for Sr. Professional Care Manager within the Insurance Services Division.

Responsibilities:

• Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care. 
• Document all activities in the Health Plan's care management tracking system 
• Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions.
•  Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health provider, and other health plan and system departments as appropriate. 
• Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate. 
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management. 
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations. 
• Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. 
• Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. 
• Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. 

Qualifications

• Minimum of 2 years of experience in a clinical setting and case management nursing required.
• BSN preferred.
• Minimum 1 year of health insurance experience required.
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
• Excellent organizational skillsHigh level of oral and written communication skills
• Computer proficiency required

Licensure, Certifications, and Clearances:

• Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role)
• CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
• Automotive Insurance
• Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
• Driver's License
• Registered Nurse (RN)
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal
• OAPSA with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran

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