Job Description

Job Title: Director, Care Management (RN)
Job ID: 669856
Status: Full-Time
Regular/Temporary: Regular
Hours: Daylight, Monday thru Friday
Shift: Day Job
Facility: UPMC McKeesport
Department: Care Management
Location: 1500 Fifth Avenue, Mckeesport PA 15132


Do you have a strong knowledge of care management and health insurance? Are you an impassioned patient advocate? Do you strive for the best outcomes for those in your care? Are you a visionary leader, and love to develop a team of staff? This could be the perfect opportunity for you!

UPMC McKeesport is actively seeking a full-time Director of Care Management to oversee all care management and spiritual care operations of our community hospital located in McKeesport, PA.

As Director, Care Management, you will assess, plan, implement, coordinate, monitor, and evaluate options and services to meet our patients' individual health needs through communication and available resources to promote quality, cost-effective outcomes.

This role will have oversight of 15 direct reports, including nurse care managers and spiritual caregivers. The position will report directly to the Chief Nursing Officer, Vice President of Patient Care Services.

Think you're up for the challenge? Apply today!

About UPMC McKeesport:

Founded in 1894, UPMC McKeesport is a nonprofit acute care community hospital that serves the 200,000 residents of McKeesport and the surrounding area. The hospital offers 216 beds for acute care patients and 56 beds for patients who need skilled nursing care. Besides a separate Intensive Care Unit and Cardiac Care Unit, the hospital offers ongoing rehabilitation and educational programs to patients with cardiac, neurologic, and orthopaedic diagnoses. We also offer emergency services.

UPMC McKeesport is in the valley of the historic Monongahela River — the Mon Valley. The Mon Valley is home to a large number of elderly residents. To serve this population, the hospital has become an approved site for the Program of All-inclusive Care for the Elderly (PACE). As a PACE site, UPMC McKeesport offers an innovative program of seamless health care to older patients. UPMC McKeesport is a teaching hospital, with residency programs in both family practice and internal medicine.

The hospital has access to UPMC’s state-of-the-art diagnostic and interventional capabilities and its extensive roster of specialists. UPMC McKeesport is committed to our communities that we serve. This commitment is visible through the health care services the hospital provides as well as through the community-focused programs sponsored by the McKeesport Hospital Foundation. We continue to serve the underserved and disadvantaged, and advance excellence and innovation throughout health care that are consistent with our mission for the benefit of the residents of our region.

  • Act as an internal resource to Vice President, Patient Services and CNO, Physician Advisor, the System-wide Care Management Leadership Group, medical staff leaders and other department managers on CM activities.
  • Allow for implementation of the nursing process.
  • Conduct annual performance evaluations.
  • Create systems and methodologies to ensure appropriate Care Manager coverage for all patient populations.
  • Define the process components of Care Management which includes establishing performance measures.
  • Determine appropriate number and type of staff required to perform the responsibilities of the department in conjunction with the Vice President, Patient Services and CNO.
  • Develop and implement process for utilizing new guidelines ensuring that documentation requirements are met and performance measures utilization and quality are in place.
  • Develop relationships with other Care Management professionals in the community, regulatory agencies, health plans, etc.
  • Direct collaboration between physician, nurses, and care managers to develop systems to ensure clinical guidelines/ pathways are used appropriately.
  • Direct resource allocation to assist faculty and staff in expediting guideline development and implementation process.
  • Employ benchmark criteria for medical necessity and appropriateness of stay , placement, and discharge.
  • Engage the Physician Advisor as appropriate.
  • Ensure all patients are screened for care management.
  • Ensure interrater consistency.
  • Ensure regulatory compliance in determining denial of service and/or providing notices on non-coverage.
  • Ensure that expenses are maintained within budget.
  • Ensure that productivity standards are met.
  • Ensure timely and accurate concurrent and retroactive review for health plans.
  • Ensure treatment plans are monitored and that the appropriate level of care is provided and that discharge planning is facilitated.
  • Establish and monitor performance and provide feedback and guidance to staff.
  • Establish care management goals in collaboration with the Vice President, Patient Services and CNO, Physician Advisor, medical staff leaders, and the System-wide Care Management Leadership Group.
  • Facilitate meeting the goals of UPMC McKeesport.
  • Facilitate the determination of benchmarks for clinical and services monitors in conjunction with the Physician Advisor and the System-wide Care Management Leadership Group and other departmental managers to allow comparison of performance against benchmark.
  • Facilitate the development and prioritization of CM projects and tasks to be managed under the oversight of the Vice President, Patient Services and CNO and the System-wide Care Management Leadership Group.
  • Facilitate the development of the written CM Program description that outlines the program structure, goals, and objectives to the program, the organizational structure that supports the program and the specific CM projects designated for the year.
  • Facilitate the reassessment and reevaluation of the goals and objectives identified in the CM Program on an annual basis.
  • Hire and terminate staff as necessary.
  • Identify priority diagnoses for implementation of clinical guidelines/pathways in collaboration with the Vice President, Patient Services and CNO and medical staff leaders.
  • Maintain a tracking system for overseeing and monitoring progress toward established goals and objectives and the CM Program.
  • Make reductions as required by organizational needs in consultation with the Vice President, Patient Services and CNO.
  • Meet standards for delegated UR functions.
  • Monitor actual expenses against budget and report variances to the Vice President, Patient Services and CNO.
  • Monitor and track variant bed days/visits and other utilization trends.
  • Monitor guidelines/pathways utilization, track variances, analyze effectiveness and report to the Vice President, Patient Services and CNO, Physician Advisors and other appropriate clinical leadership groups.
  • Oversee, support and monitor the progress of various CM projects and studies.
  • Participate as a member of various committees to ensure that actions and issues are consistent with the CM Program goals and objectives.
  • Participate in the development of the CM department annual budget and plan for departmental needs under the direction of the Vice President, Patient Services and CNO.
  • Prepare materials and conduct presentations or in-services on Resource and Utilization Management and Care Management.
  • Provide a comprehensive, integrated approach to the care and reimbursement of common, high cost, chronic illnesses.
  • Provide day-to-day departmental management and supervision of care managers and social workers.
  • Provide for adequate communication among healthcare providers.
  • Provide role satisfaction to nurses.
  • Provide updates to the Medical Executive Committee and the System-wide Care Management Leadership Group regularly.
  • Report CM activities and corrective actions to the Vice President, Patient Services and CNO, Physician Advisor and the System-wide Care Management Leadership Group as appropriate.
  • Report data to the Vice President, Patient Services and CNO and System-wide Care Management Leadership Group and assists in implementing corrective actions as deemed appropriate.
  • Work as the insurer's liaison to resolve disputes between provider, patient, and the insurer regarding needed levels of care and authorizations for reimbursement.
  • Work with nursing leadership (CNO, Senior Director) to ensure each unit's care delivery structure.


  • Registered Nurse
  • Masters degree in a related field required
  • 5 years progressive leadership experience in a health care setting required
  • Previous care management or insurance experience strongly preferred
  • Certification a plus, but not required
  • Evidence of leadership, creativity, and initiative to plan, organize and integrate complex interdepartmental programs, function independently, communicate verbally and in writing and establish rapport with physicians and others. 
  • Experience with Microsoft Word, Excel, Access, and Canopy.
  • Use of InterQual criteria preferred.
Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance
  • Older Adult Protective Services Act
  • Registered Nurse
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

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