Job Description

Job Title: UPMC Care Management Networking Event, Tuesday June 26th, 5pm-7pm
Job ID: 180000PE
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department:
Location: , Pittsburgh PA

Description

Care Management Networking Event
You are invited – Experienced RNs


If you are an experienced inpatient nurse or nurse case manager looking to start or further your career in care management at one of our many hospitals, join us at Southern Tier!

UPMC Care Management Networking Event
Tuesday June 26th  from 5:00 p.m. to 7:00 p.m.
Southern Tier Brewing
316 N Shore Dr, Pittsburgh, PA 15212
Convenient Street, Lot, or Garage Parking


We look forward to meeting you in this relaxed setting to share the inside scoop on current openings and options in care management at UPMC.

Drop by after work to see us. Conveniently scheduled for after hours.

What you can expect:
  • Meet our recruiters 
  • Meet hiring managers
  • Meet with Professional Care Managers working at UPMC hospitals 
  • Good food, Good drinks
To reserve your spot at our Care Management Networking Event, email or call, Michelle, at magdziukm@upmc.edu, 412-454-1595.

We will hope to see you there! 




The Professional Care Manager, a nurse, is an expert in resource management, a master of regulatory compliance, a superb communicator, and above all a compassionate partner for each individual patient. Able to balance complex clinical scenarios with the patient’s social, emotional, spiritual, and economic needs, the Professional Care Manager is a strong clinician who works closely with physicians, nurses, and other caregivers to assist in progressing the patient along the continuum of care.

Healing is just one aspect of a hospital stay. For patients and their families, there are many clinical opinions, specialist referrals, treatment choices, and financial considerations at play--navigating all of that can be a confusing and overwhelming process. They need an advocate, someone who foresees their needs, knows their options, and begins strategizing their way home from the moment of admission.

An essential member of the care delivery team, you will apply your own judgment and problem-solving skills to ensure each patient is provided with efficient, quality care while minimizing risks, delays, and unnecessary costs. You will work hand-in-hand with the multidisciplinary team as well as internal and external providers and agencies to execute a safe discharge and a clear path forward for patients and their families, including plans for self-management, at-home care, and post-acute referrals and outreach, as needed.

The Professional Care Manager is a valued step in the UPMC nursing career ladder, with opportunities for continued growth and upward advancement.

Responsibilities:
  • Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources. Ensures compliance with all payer and government regulations.
  • Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services. Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care. Documents Freedom of Choice re: post-acute services.
  • Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.) Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations.
  • Promotes patient safety. Supports CORE measures information for JCAHO requirements.
  • Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
  • Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
  • Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system.
  • Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.

Qualifications

CM Requirements:
  • Graduate of approved school of nursing.
  • 2 years of nursing experience required.
  • BSN or related Bachelors degree strongly preferred for Professional level, required for Senior level.
  • 2 years of care management experience or equivalent experience in the healthcare environment preferred
  • Knowledge of healthcare financial and payor issues preferred.
  • Knowledge of state, local, and federal programs required.
  • Use of InterQual criteria preferred.
Licensure, Certifications, and Clearances:

  • Currently licensed as professional nurse in the Commonwealth of PA.
  • UPMC Corporate Care Management Training Certificate of Completion required with 4-6 weeks of hire.
  • UPMC approved Care Management certification preferred
  • Act 34 Criminal Clearance
  • Registered Nurse

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

Salary Range: $0 to $0

Union Position: No

Apply Current Employee?

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DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

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