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Job Description

Job Title: Care Manager- UPMC Western Psychiatric Hospital
Job ID: 744377377
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Western Psychiatric Institute
Department: Care Management
Location: 3811 O'hara Street, Pittsburgh PA 15213

Description

Purpose:

UPMC Western Psychiatric Hospital is seeking a dedicated full time Care Manager. This position will work daylight Monday- Friday 8:30AM- 5PM. 


The Care Manager will assist the inpatient treatment teams to ensure appropriate level of care for all patients. The Care Manager will coordinate insurance reviews including pre-certification, continued stay reviews, retrospective reviews, and denial/appeal activity and documentation as needed.

Responsibilities:
  • Demonstrates proficiency in Psych Consult Care Management, Psych Consult Provider, Medipac, & SharePoint.
  • Documents pertinent clinical information on the Care Management Abstract.
  • Participates in telecons, grievance hearings, and DPW pre-hearings/hearings.
  • Reviews and completes MA late pick-ups
  • Effective communication with WPIC management regarding authorization challenges, MCO changes, disposition challenges, updates regarding cases in denial, etc.
  • Completes accurate, timely, and thorough documentation in the Psych Consult Care Management application.
  • Displays a positive attitude and be a helpful team member within the CM department.
  • Participates in departmental performance improvement projects.
  • Completes pre-certification and continued stay reviews within the designated MCO timeframes.
  • Gathers and maintains current patient progress from unit documentation, treatment team meetings, disposition meetings, etc.
  • Maintains a thorough understanding of Care Management standards and processes as defined the various managed care organizations.
  • Writes letters for provider appeals, member grievances, & DPW requests.
  • Collaborates with multiple departments within UPMC (e.g. Fiscal, Patient Access, DEC, and PBS).
  • Coordinates MD-MD reviews with the MDs and CM administrative staff.

Qualifications

  • RN or Master's level degree required, plus 3 years of clinical experience. 
  • Managed Care Experience preferred

Licensure, Certifications, and Clearances:
  • Registered Nurse (RN)
  • Act 31 Child Abuse Reporting
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $21.64 to $37.36 / hour

    Union Position: No

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