Job Description

Job Title: Professional Care Manager (RN)
Job ID: 764027
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Chautauqua WCA
Department: Case Management
Location: 207 Foote Avenue, Jamestown NY 14702

Description

UPMC Chautauqua seeks a full-time Professional Care Manager to coordinate the care plans for our patients. 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.

This role requires 40 hours/week. Weekend hours will be required.

An essential member of the care delivery team, you will apply your own judgment and problem-solving skills to ensure each patient is provided with efficient, quality care while minimizing risks, delays, and unnecessary costs. You will work hand-in-hand with the multidisciplinary team as well as internal and external providers and agencies to execute a safe discharge and a clear path forward for patients and their families, including plans for self-management, at-home care, and post-acute referrals and outreach, as needed.

The Professional Care Manager is a valued step in the UPMC nursing career ladder, with opportunities for continued growth and upward advancement.

Responsibilities:
  • Based on assessment of members needs and environment, indentify applicable barriers, problems, goals, and interventions that will address those needs and improve or maintain the health status of the member.
  • Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
  • Contact potential case management members to determine if there is a need for case management intervention based on the UPMC Health Plan protocols and timeframes established for the applicable clinical program.
  • Follow-up with the member according to established clinical program protocols and timeframes to monitor their status, evaluate the effectiveness of the individualized plan of care, and identify new needs. Modify the individualized plan of care or case status based on the status of the member.
  • Perform duties and responsibilities in accordance with the philosophy and standards of the UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts
  • Provide case management according to program descriptions including member education, follow up on a timely basis and eliminating barriers to care.
  • Successfully engage member to develop an individualized plan of care to promote healthy lifestyles, close gaps in care, reduce unnecessary ER utilization and hospital readmissions. Develop and coordinate the individualized plan of care with the member, member's family, providers and community agencies as applicable. Involve other staff to support the individualized plan of care based on identified needs of the member

Qualifications

  • Graduate of approved school of nursing. 
  • Two (2) years of nursing experience required.
  • BSN or related Bachelors degree preferred.
  • Five years of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
  • Knowledge of healthcare financial and payor issues preferred.
  • Knowledge of state, local, and federal programs preferred.
  • Use of InterQual criteria preferred.
  • Computer proficiency required. 
  • Excellent verbal and written communication and interpersonal skills required

Licensure, Certifications, and Clearances:
  • Valid New York RN licensure required.  
  • Case Manager certification preferred. 
  • PA RN license preferred, or willingness to get a PA RN license strongly preferred.
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $22.11 to $37.86

Union Position: No

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