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Professional Care Manager, Supervisor (RN)

  • Job ID: 656757194
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Clinical Ops Admin
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

Are you an experienced nurse with a firm knowledge of utilization management? Are you looking to continue your career in a leadership position? We are looking for you for this fantastic opportunity! 

UPMC Health Plan is hiring a full-time Supervisor, Professional Care Management to support our Clinical Operations Department. This position will primarily work remotely with periodic work in the US Steel Tower in downtown Pittsburgh.  The ideal candidate will be an independent critical thinker who is adaptive in a fast-paced environment.

The position will work standard daylight hours, Monday through Friday with rotating weekend on-call responsibilities.

The Supervisor is responsible for oversight and day-to-day care coordination functions for a team of Medical Review Specialists, including the direct supervision, coaching, and counseling of staff.  The Supervisor monitors staff workload, assignments, and productivity and assists care managers with problem-solving with complicated member cases.  This role acts as a resource for staff and other departments within the Health Plan. The role includes orientation and onboarding for clinical staff and mentorship of staff in order to achieve departmental goals. The Supervisor contributes or completes performance reviews for staff.

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 workflow 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 onboarding 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.
  • Two years of supervisory or leadership experience preferred.
  • Utilization management 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

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   Current UPMC employees must apply in HR Direct