Job Description

Job Title: Professional Care Manager, Supervisor
Job ID: 27556383
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

UPMC Health Plan is hiring a full-time Professional Care Manager Supervisor to support the Utilization Management Clinical Operations Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.

 

The ideal candidate will be an experienced supervisor with extensive experience in utilization management.

 

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.  This role monitors staff workload, assignments, and productivity and assists care managers with problem-solving complicated member cases by acting as a resource for staff and other departments within the Health Plan. The Supervisor facilitates orientation and onboarding for clinical staff and mentors and completes performance reviews for staff in order to achieve departmental goals.

 

Responsibilities:

  • Ensure staff receives, understand and adhere to applicable regulatory/ compliance guidelines related to their departmental expectations (I.E. NCQA, DPW, CMS).
  • Conduct regularly scheduled team and individualized meetings to communicate information, ongoing education and/or individual performance feedback.
  • 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.
  • Monitor, coach and report staff productivity and adherence to regulatory and work flow standards. Manage staff schedules to ensure that departmental goals are met
  • Contribute to the development, implementation and annual review of departmental policies and procedures.
  • 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.
  • Collect data, validate data where possible, prepare reports and assist teams in analysis and monitoring of key utilization targets and trends.
  • 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.
  • Assess staff member's ability to engage members and provide coaching to increase the use of motivational techniques. Complete performance evaluations within departmental timeframes
  • 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.

Qualifications

  • Bachelor's degree in nursing or related field required
  • 2 years of nursing experience required
  • 4 years of care manager experience required
  • Managed care experience preferred
  • Utilization management experience highly 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 (RN) 
UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $32.46 to $55.43 / hour

Union Position: No

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