Job Description

Job Title: Manager, Medical Management (RN)
Job ID: 729912
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Improvement
Location: 600 Grant St, Pittsburgh PA 15219

Description

Do you at least five years of clinical experience and three years in managed care? Are you a proven leader/supervisor? Are you looking to take the next step in your career? If so, UPMC may have the perfect fit for you!

UPMC is hiring a full time Manager, Medical Management to support our Quality Improvement team. This will be a Monday through Friday daylight role located in Pittsburgh, PA. 

The Manager is responsible for the day-to-day care coordination functions through the management of staff and activity which may include behavioral health, utilization management, case management and care coaches. Serves as a liaison to government and other regulatory agencies, and internal departments. Monitors and collects information related to staff and program performance, reviews performance against goals and makes recommendations for improvement.

Responsibilities:
  • Assists in the development and implementation of new or revised programs. Monitor progress, develop recommendations for improvement, and monitor action plans to ensure the integrity of the programs are maintained and deadlines are met.
  • Assists in the development of and revision of care management programs, policies and procedures.
  • Conducts regularly scheduled team meetings to communicate key information, engage staff in daily operations, and provide ongoing staff education related to all relevant areas of Medical Management while nurturing a team approach.
  • Facilitates detailed case reviews with appropriate Health Plan team members including physicians to identify barriers to care and initiate appropriate team coordination.
  • Monitors, coaches, and reports staff activity and productivity and assists teams in analysis and monitoring of key utilization targets and trends Assists staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas
  • Performs duties and responsibilities in accordance with the philosophy and standards of the UPMC Health Plan, including conveying courtesy, respect, enthusiasm, integrity, innovation and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
  • Responsible for HEDIS interventions: Supports and trains staff, assisting with problem-solving and managing case referrals and work flows. Monitors, coaches and reports staff activity and productivity, and assists teams in analysis and monitoring key HEDIS gaps in care metrics. Provides ongoing staff education related to all relevant areas of HEDIS specifications while nurturing a team approach. Coordinates network provider communication and education regarding members' gaps in care, provider profiles and assists in improvement initiatives as appropriate.
  • 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.
  • Supports supervisors in training, assisting staff with problem-solving, and managing case referrals and work flows

Qualifications

  • BSN or masters degree in a health-related profession required . 
  • Five years of clinical experience required. 
  • Three years of experience in a managed care environment required. 
  • Prior management, supervisory, or leadership experience required. 
  • Excellent interpersonal and communication skills (verbal and written) required. 
  • Strong organizational and problem-solving skills with the ability to make decisions independently.
  • Proficiency with Microsoft Office products required. 
  • Ability to develop and maintain an effective team-focused working environment.
  • Ability to analyze data and identify trends.

Licensure, Certifications, and Clearances:
  • Certified Case Manager certification preferred.
  • Registered Nurse

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

Salary Range: $30.89 to $52.76

Union Position: No

Apply Current Employee?

UPMC VALUES

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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