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   Current UPMC employees must apply in HR Direct

Case Manager-Case Management

  • Job ID: 871632665
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Chautauqua at WCA
  • Department: Case Management
  • Location: 207 Foote Avenue, Jamestown NY 14702
  • Union Position: No
  • Salary Range: $16.04 to $25.55 / hour

Description

Description:

Provide case management according to program descriptions including member education, follow up on a timely basis and eliminating barriers to care.

Purpose:

  • Based on assessment of members needs and environment, indentify applicable barriers, problems, goals, and interventions that will address those needs and improve or maintain the health status of the member.
  • Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member.  Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
  • Contact potential case management members to determine if there is a need for case management intervention based on the UPMC Health Plan protocols and timeframes established for the applicable clinical program.
  • Follow-up with the member according to established clinical program protocols and timeframes to monitor their status, evaluate the effectiveness of the individualized plan of care, and identify new needs.  Modify the individualized plan of care or case status based on the status of the member.
  • Perform duties and responsibilities in accordance with the philosophy and standards of the UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts
  • Successfully engage member to develop an individualized plan of care to promote healthy lifestyles, close gaps in care, reduce. unnecessary ER utilization and hospital readmissions.  Develop and coordinate the individualized plan of care with the member, member's family, providers and community agencies as applicable.  Involve other staff to support the individualized plan of care based on identified needs of the member.

Qualifications

Educational and Knowledge Requirements:

  • Five years of experience in clinical, utilization management, home care, discharge planning, and/or case management required.
  • Three years of experience in a managed care environment preferred.
  •  Ability to interact with physicians and other health care professionals in a professional manner required.
  • Computer proficiency required. 
  •  Excellent verbal and written communication and interpersonal skills required.

Licenses and Certifications:

  • Registered Nurse (RN)(NYS)
  •  Bachelor's degree in nursing preferred.
  • Case Manager certification preferred.

 

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct