Job Description

Job Title: Professional Care Manager (RN) - Job Share
Job ID: 712227
Status: Job Share
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Presbyterian
Department: Collaborative Case Mgt
Location: 3708 Fifth Avenue, Pittsburgh PA 15213

Description

Do you have a strong interest in care management? Are you interested in working onsite in a hospital setting, but want to work daylight hours? Do you need a position that offers you flexibility with your personal life? This opportunity may be a perfect fit! UPMC Presbyterian is hiring a JOB SHARE Professional Care Manager.

The position will work standard daylight hours, Monday through Friday. The position is a job share, allowing you the flexibility of working 40 hours every 2 weeks, in accordance with the schedule you will establish together with leadership and the incumbent nurse holding the other half of the job share. UPMC job share employees are afforded with full-time benefits coverage.

**Nurses with 2 years of nursing experience may be considered for this position. The title and salary range of the position may vary depending on education level and any years of relevant case management background. Salary range as posted is for Sr. level Care Manager.**

The 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.

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.
  • Evaluated issues, trends and recommends improvement to Care Manger Manager/Director and/or multi-disciplinary team.
  • 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 advancement of knowledge and skills of other disciplinary teams and lay members of the community by serving as a resource to internal and external individual groups.
  • 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 a leader within the care management department in completing his/her assignment.
  • Serves as a role model of excellent customer service and patient care.
  • 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

  • Graduate of approved school of nursing.
  • Two years of nursing experience required.
  • Two years hospital inpatient nursing experience strongly preferred
  • BSN or related Bachelors degree preferred for Professional level, required for Senior level.
  • Two years of care management experience or equivalent experience in the healthcare environment preferred, or required for Senior level
  • 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: $30.89 to $52.76

Union Position: No

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