Job Description

Job Title: Professional Care Manager, Supervisor (RN) - Inpatient Utilization Management
Job ID: 720845
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: UM Clin Ops
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you an experienced inpatient nurse who has a passion for care management? Are you ready to take the next step in your career by moving into a leadership role? UPMC Health Plan is hiring a Full-Time Professional Care Manager, Supervisor to help support the Utilization Management department. This position is based in Downtown Pittsburgh, this role will supervise and support the UM Care Managers. 

The position will work standard daylight hours, Monday through Friday.

The Supervisor is responsible for oversight and day-to-day care coordination functions for telephonic, clinical, or utilization management care management staff, including the direct supervision, coaching and counseling of staff. Monitors staff workload, assignments, and productivity. In this role, you will have the unique opportunity to assist care managers with problem solving with complicated member cases. You will act as a resource for staff and other departments within the Health Plan. You will also facilitate orientation and on boarding for clinical staff, and mentor staff in order to achieve departmental goals.

Responsibilities:
  • Assess staff member's ability to engage members and provide coaching to increase the use of motivational techniques. Complete performance evaluations within departmental timeframes
  • Collect data, validate data where possible, prepare reports and assist teams in analysis and monitoring of key utilization targets and trends.
  • Conduct regularly scheduled team and individualized meetings to communicate information, ongoing education and/or individual performance feedback.
  • Contribute to the development, implementation and annual review of departmental policies and procedures.
  • Contribute to the development, implementation, and evaluation of clinical programs within the team or department. Assist with integrating HP programs across the Health System and vendors as needed.
  • Ensure staff receives, understand and adhere to applicable regulatory/ compliance guidelines related to their departmental expectations (I.E. NCQA, DPW, CMS).
  • Facilitate staff orientation and on boarding for new staff. Monitor staff participation in mandatory education and competency assessment requirements at the system, Health Plan, and department level.
  • Monitor, coach and report staff productivity and adherence to regulatory and work flow standards. Manage staff schedules to ensure that departmental goals are met
  • Participate in interdisciplinary treatment team meetings to facilitate the development of appropriate and comprehensive plans of care. Assist staff in making referrals to community or governmental agencies.
  • Serve as a resource to staff and other Health Plan departments to identify opportunities for improvements, quality of care concerns, and barriers to care coordination. Utilize evidence based practice to support improvement in care / health / utilization management.

Qualifications

  • Bachelors degree in nursing or related field required
  • 2 years of nursing experience required
  • 4 years of care manager experience required
  • Managed care experience preferred
  • Two years of supervisory or leadership experience preferred. 
  • Case management certification or approved clinical certification within one year of hire or 1 year health plan management experience required  
  • Ability to analyze data and monitor trends required 
  • Proficiency with Microsoft Office products  
  • Excellent interpersonal and communication skills (verbal and written); Ability to collaborate effectively with physicians and other health care professionals
  • Strong organizational and problem solving skills with ability to make decisions independently 
  • Ability to develop and maintain effective team-focused working environment

Licensure, Certifications, and Clearances:
  • Case management certification or approved clinical certification within one year of hire or 1 year health plan management experience required
  • 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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