Description

The outpatient Professional Care Manager is responsible for the coordination of care for patients who have complex medical and/or psychosocial needs and who require intensive care management. Patients with complex needs will be routinely identified through case review, referral from inpatient case management, referral from physician practices, predictive analytics, and other reliable data sources. This individual plays a pivotal role in the Patient Centered Medical Home (PCMH) by collaborating with the primary care physicians and an interdisciplinary team to develop a plan of care for the highest risk patients.

The Professional Care Manager establishes an interdisciplinary approach in working with patients, families, and the care team (e.g. social work, inpatient and specialist care coordinators, pharmacist, etc.) to utilize evidence-based resources to establish appropriate interventions and goals of care. This individual implements, coordinates, monitors, and evaluates appropriate resources using evidenced based standards. The goals of care management are to maintain clinical stability, promote appropriate utilization of services, enhance patients' ability to better manage their health and disease, and improve the patient's health status, clinical outcomes, and satisfaction. Patient outreaches are performed in person via a home visit or office visit, or by telephone or video visit. 

Qualifications

• Graduate of approved school of nursing.
• Two (2) years of nursing experience required.
• BSN or related Bachelors degree preferred.
• Previous case management experience preferred.
• Knowledge of healthcare financial and payor issues preferred.
• Knowledge of state, local, and federal programs preferred.
• Use of InterQual criteria preferred.
  
  Licensure, Certifications, and Clearances:
  Currently licensed as professional nurse in the Commonwealth of PA. UPMC Corporate Care Management Training Certificate of Completion required with 4-6 weeks of hire. UPMC approved Care Management certification preferred
  
  Clearances needed within 90 days
  
  

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.