Job Description

Job Title: Manager, Care Management (RN)
Job ID: 754437
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: POP00 Medical Management
Location: 3600 Forbes Ave, Pittsburgh PA 15213

Description

Are you an experienced nurse care manager with proven leadership capabilities? Why not consider taking on the next challenge in your career in management? University of Pittsburgh Physicians is hiring a full-time Manager, Care Management to support the Medical Management department. 

This position will work standard daylight hours, Monday through Friday. The position will be based out of Forbes Tower but travel is required to visit offsite locations to observe and support the team. This position will have the responsibility of supporting three groups of care managers. 

The Manager is responsible for the operational functions of a care, health, or utilization management team including the direct supervision, coaching and counseling of clinical staff. Collects and monitors reports related to staff performance; reviews performance against Health Plan goals and completes staff evaluations; and makes recommendations for improvement. Contributes to program evaluations for clinical initiatives that enhance member satisfaction, improve quality of care, and reduce cost. Represents the director upon request by servicing as a liaison to internal departments or government or employer based agencies.

Responsibilities:
  • Analyzes data for trends and causative factors that promote or impede progression toward positive care management outcomes.
  • Analyzes data for trends related to variation in actual vs. targeted length of stay.
  • Assists with management of departmental budget.
  • Collaborates with CM Director, Medical Director/Physician Advisor and staff to ensure effective processes and systems are established and maintained to meet department goals.
  • Collaborates with other UPMC departments to establish mechanisms to address issues related to care management, tracks, trends avoidable day/delay documentation and reports to Director trends/barriers.
  • Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators.
  • Collaborates with other staff to develop performance improvement activities as indicated.
  • Conducts employee performance reviews.
  • Conducts inter rater reliability audits per established policy.
  • Coordinates daily flow of the department (this includes overseeing PTO requests, assignment coverage, weekend coverage)
  • Coordinates with CM in an effort to meet the established length of stay targets.
  • Coordinates with CM staff to ensure safe/effective/efficient plans of care are implemented
  • Develops and implements processes for timely and accurate documentation of appropriate data relating to concurrent denials.
  • Develops reporting tools to assist CM Director and executive leadership teams to assess the effectiveness of CM efforts.
  • Ensures training programs address identified needs of CM staff
  • Functions as a resource person for the care management and denial management processes.
  • Monitors and mentors Care Management staff.
  • Oversees daily operations of the Care Manager (CM) staff under the direction of the Director of Care Management.
  • Participates in leadership development.
  • Takes a leadership role in the mentoring and monitoring of documentation expectations in Care Management technology.
  • Utilizes identified denial trends to develop training tools to facilitate maximum financial reimbursement.

Qualifications

  • Master's degree in nursing or related field required
  • Minimum of 2 years of nursing experience required
  • Minimum of 4 years of care manager experience required
  • Case management certification or approved clinical certification required OR 2 years health plan management experience required
  • Prior management, supervisory, or leadership experience required.
  • Three years of experience in a managed care environment preferred.
  • Ability to analyze data and identify trends
  • 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 required or 2 years health plan management experience required
  • Act 34 Criminal Clearance
  • Registered Nurse

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

Salary Range: $33.94 to $57.47 / hour

Union Position: No

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