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

Clinical Service Representative I - Temporary

Description

UPMC Health Plan's Clinical Operations team is seeking a Temporary Clinical Service Representative I! This role is eligible for work-from-home opportunities based on performance and to managements discretion. This role will work standard daylight hours, Monday through Friday,

The Clinical Service Representative (level 1) acts as an advocate for Health Plan customers (members, providers, facilities etc.) by providing guidance, interpretation and education on benefit coverage levels, Health management/Case management programs and various program inquiries. Responsible for efficient and courteous resolution of verbal and written inquiries to ensure customer satisfaction while maintaining call service and quality standards. Clinical Service Representative (level 1) will also provide non-clinical support for the Medical Management activities by serving as the first line of contact for utilization management activities. 

Responsibilities:

  • Perform reviews for Radiology, Cardiology and MSK cases and partner with our third-party vendor
  • Must be able to multitask and work in multiple systems
  • Perform callbacks to members/providers to supply authorization decisions
  • Conduct and document outbound calls to clarify, follow-up and resolve customer inquiries
  • Create cases in the authorization system when appropriate
  • Manage and triage calls and electronic cases that may or may not require clinical intervention
  • Conduct outbound member and provider calls in accordance with department initiatives and regulatory requirements
  • Maintain or exceed designated quality and production standards
  • Must adhere to all HIPPA regulations
  • Remain current on all department policies, procedures, plan benefit designs and modification
  • Provide assistance to other departments during periods of backlog
  • Maintain strict confidentiality related to medical records
  • Answer incoming inquiries from UPMC Health Plan members and providers

 

Qualifications

  • High School Diploma Strongly Preferred
  • 1 year of customer service or call center experience preferred
  •  1 year clerical, data entry or office experience preferred 
  • Ability to make independent decisions 
  • Medical Terminology or experience in health care environment preferred
  • Basic analytical skills necessary to evaluate customer inquiries
  • Computer proficiency in database, word processing and spread sheet management required
  • Excellent organizational, communication and problem-solving skills required
  • Schedule flexibility to meet business needs
  • Detail oriented


Licensure, Certifications, and Clearances:

  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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

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If you suspect you have been a victim of a fraudulent UPMC job offer, please report the attempt using this form.