Job Description

Job Title: Manager, Care Management (RN)
Job ID: 664137
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC St. Margaret
Department: Care Management
Location: 815 Freeport Road, Pittsburgh PA 15215


Are you an experienced, dynamic nurse leader who possesses a strong familiarity with the field of Care Management? Put your skills to the test! UPMC St. Margaret is hiring a full-time Manager, Care Management to provide leadership over the Care Management department.

The Manager oversees the day-to-day operations of the Care management department under the direction of the Director. The Manager is accountable for the following Care Management functions: training, auditing, systems support: Care Management Technology, InterQual, Concurrent Denials and reporting. Leads efforts to develop, implement, evaluate, redesign and modify Care Management practice standards. Works closely with the CM staff in an effort to safely, effectively and efficiently move patients across and through the continuum of care.

  • Analyzes data for trends and causative factors that promote or impede progression toward positive care management outcomes.
  • Analyzes data for trends related to variation in actual vs. targeted length of stay.
  • Assists with management of departmental budget.
  • Collaborates with CM Director, Medical Director/Physician Advisor and staff to ensure effective processes and systems are established and maintained to meet department goals.
  • Collaborates with other UPMC departments to establish mechanisms to address issues related to care management, tracks, trends avoidable day/delay documentation and reports to Director trends/barriers.
  • Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators.
  • Collaborates with other staff to develop performance improvement activities as indicated.
  • Conducts employee performance reviews.
  • Conducts inter rater reliability audits per established policy.
  • Coordinates daily flow of the department (this includes overseeing PTO requests, assignment coverage, weekend coverage)
  • Coordinates with CM in an effort to meet the established length of stay targets.
  • Coordinates with CM staff to ensure safe/effective/efficient plans of care are implemented
  • Develops and implements processes for timely and accurate documentation of appropriate data relating to concurrent denials.
  • Develops reporting tools to assist CM Director and executive leadership teams to assess the effectiveness of CM efforts.
  • Ensures training programs address identified needs of CM staff
  • Functions as a resource person for the care management and denial management processes.
  • Monitors and mentors Care Management staff.
  • Oversees daily operations of the Care Manager (CM) staff under the direction of the Director of Care Management.
  • Participates in leadership development.
  • Takes a leadership role in the mentoring and monitoring of documentation expectations in Care Management technology.
  • Utilizes identified denial trends to develop training tools to facilitate maximum financial reimbursement.


  • Graduate of an accredited school of nursing  
  • Four-Six (4-6) years nursing experience required
  • Bachelors degree required 
  • Masters degree required 
  • Four (4) years care management experience or equivalent experience in healthcare environment required. 
  • Inpatient hospital experience needed
  • Manages care and payor experience preferred
  • Supervisory/management experience preferred
  • Proficiency with analytical and reporting software tools
Skills Required: 
  • Ability to build credible and effective relationships with physician leadership.
  • Strong analytical skills
  • Proficient in Microsoft Excel and Access
  • Strong project management skills 
  • Excellent communication and interpersonal skills
  • Demonstrated leadership capabilities
Behavioral Dimensions: 
  • Current knowledge of medical care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization/case management, discharge planning, Medicare, Medicaid, and other third party payor requirements, and managed care principles preferred. 
  • Use of expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care among all health care providers while maximizing use of resources is required.
  • The ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action is required. 
  • Expertise in interpersonal relationships, organizational relations, and effective communication, negotiation, and conflict resolution skills are required. 
  • The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required. 
  • Strong sense of commitment and of being in control of one's practice is needed. Ability to effectively resolve practice issues and facilitates practice changes within the organization and throughout the continuum of care is required.
  • Ability to foster principles of participative management by identifying/involving relevant individuals in program-related decisions is required. 
  • Ability to apply creative and innovative approaches to develop and maintain systems that achieve higher levels of multi-disciplinary team performance and desired patient outcomes is needed.

Licensure, Certifications, and Clearances:
  • Current Nursing Licensure in the Commonwealth of Pennsylvania
  • UPMC approved Care Management certification or agreement to obtain upon hire required. 
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $30.79 to $49.91

Union Position: No

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