Job Description

Job Title: Supervisor, Health Manager- Health Plan
Job ID: 724115
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Pop Health Case Mngt
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you a licensed professional with at least 5 years' experience in behavioral health clinical, care coordination, and/or case management? Do you have experience working in a managed care environment? If this sounds like you, UPMC may have the perfect fit for you!


UPMC Health Plan is hiring a full-time Supervisor, Health Manager to support the Adult Case Management department. This is a Monday through Friday daylight (8:00 a.m. - 4:30 p.m.) position and will be based in downtown Pittsburgh, PA. Approximately 30% travel to provider sites and throughout the community will be required.



The Supervisor, Health Manager is the point person for Mobile Social Workers including Case Managers and ensures continuity and coordination of care for Health Plan members with illnesses and complex needs. The Supervisor, Health Manager is responsible for the day to day oversight of case assignment and complex issues that arise in the call center as well as supervision of the behavioral health coaches.


Responsibilities:

  • Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
  • Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and network providers.
  • Assists in the development and revisions of programs, policies, and procedures.
  • Assumes responsibility for health plan member's access to in-plan and/or supplemental services as medically indicated.
  • Ensure adequate staff coverage and phone coverage for all shifts as well as transition to afterhours clinical care.
  • Independent problem solving based on sophisticated knowledge of in-plan services, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization.
  • Maintains an understanding of behavioral health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and behavioral health management policies and procedures.
  • Oversee performance of health managers and works with direct supervisor for administrative and clinical issues.
  • Participate in integrated care team meetings in a cross cultural environment to coordinate transitions of care, discharge planning, benefit coverage, conflict resolution and resource needs.
  • Perform duties and responsibilities in accordance with the philosophy and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
  • Performs clinical reviews, service authorization and care coordination and oversight and supervision of other team members for all Health Plan members receiving services.
  • Preserve confidentiality of the member.
  • Provide reports on case management cases or activities as requested.
  • Receives and responds to complex calls regarding requests for services or resolution of complex issues.
  • Serves as a resource to staff and other Health Plan departments to identify opportunities for improvements, quality of care concerns, barriers and root causes, and participates in the member complaint and grievance process.
  • Supervise collection of information from members and health coaching staff concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures which improve the flow of services to members.
  • Supervises behavioral health staff, which includes, but is not limited to: Monitors, coaches, and reports staff activity/productivity on a weekly, monthly, and quarterly basis Monitors and assists staff in problem-solving and managing case referrals and work flows Assists staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas Evaluates staff performance on an ongoing basis, completes timely EPRs, and initiates corrective action, as appropriate
  • Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues.

 

Qualifications

  • Masters degree and Pennsylvania Licensure in health or human services field; OR licensed RN (BSN preferred)
  • Five years of experience in behavioral health clinical, care coordination, and/or case management required.
  • Three years of experience in a managed care environment preferred.
  • General knowledge of best practices in behavioral health, emphasizing work with special needs populations and in provider systems
  • Computer proficiency required.
  • Experience with Excel and Access databases preferred.
  • Excellent verbal and written communication and interpersonal skills required.
  • Knowledge of community resources required

    Licensure, Certifications, and Clearances:

    Clinical Licensure or RN Licensure Case Manager certification preferred

  • Clinical Social Worker or Licensed Professional Counselor or Licensed Social Worker or Registered Nurse

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

 

Salary Range: $28.37 to $47.88

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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