Description

UPMC Sugar Creek Station is hiring a Care Manager!

This is a Full Time position, working Daylight hours.

Join the team that’s providing the highest quality of home health care in our communities. With state-of-the-art safety protocols and the support of an academic medical center, UPMC Senior Services has demonstrated a continued commitment to keeping both our residents and our employees safe and healthy, especially throughout the COVID-19 pandemic.

Make a true impact in your community where you’ll have the confidence that your care is clinically backed by a best-in-class health care system and the rewarding knowledge that you are changing lives every day.

Responsibilities:

• Apply clinical knowledge to determine if resident requires a change in level of care or care setting and communicates with physicians and third party payers to facilitate appropriate level of care changes.
• Educate residents/families and interdisciplinary team regarding third party payor requirements and other aspects related to benefit coverage. e.g., notices of non-coverage.
• Perform daily clinical review utilizing InterQual criteria as a guide to validate whether resident meets admission or continued stay criteria.
• Collaborate with the interdisciplinary team to facilitate appropriate discharge.
• Obtain consent to appeal on behalf of the resident on all final outcome of denial situations.
• Call payors to obtain authorizations, interpret insurance benefits, review levels of care, and provide requested information.
• Perform daily medical record reviews, monitoring appropriate length of stay to meet care needs, identifying barriers to discharge, and collaborating with external case managers.
• Consult with the Physician Advisor when needed to address medical decisions requiring review.
• Ensure current understanding of guidelines and requirements of payors, external agencies, and regulations.
• Promote resident safety.
• Coordinate and facilitate resident progression throughout the continuum of care.

Qualifications

• 2 years nursing experience in LTC/Acute Care setting required
• BSN and/or Bachelors degree in health related field preferred

Licensure, Certifications, and Clearances:
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire.
 

• Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
• Registered Nurse (RN)
• Act 34
• OAPSA


• UPMC is an Equal Opportunity Employer/Disability/Veteran

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.