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Medicaid Clinical Coordinator

  • Job ID: 892961992
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Medical Mgmt Medicaid
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

UPMC Health Plan is hiring a full-time Medicaid Clinical Coordinator to support the Medical Management Medicaid Department in its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.

The Medicaid Clinical Coordinator is responsible for coordinating all clinical initiatives for pediatric Medicaid members to ensure a focused, clinically sound, cost-effective Medicaid care model. The Clinical Coordinator is the key staff responsible to coordinate the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) programming with the Department of Human Services (DHS). This includes the collection of documents requested by DHS for onsite reviews, audits or individual case reviews, and ad-hoc requests. This position will also assist department supervisors and their staff in case reviews to develop effective integrated care coordination plans. This position works across internal departments, clinical sites, community sites, and DHS to create collaborative pediatric initiatives across these areas. This position may include future travel to provider sites and community meetings.

The ideal candidate will have prior Medicaid experience and a background in healthcare program management.

Responsibilities:

  • Assists in the creation and revision of department policies and procedures.
  • Assists supervisors in developing and implementing staff professional development and mentoring program.
  • Supports special initiatives for Medicaid product both internal and external.
  • Coordinate activities of case management, utilization management, preventive services, inpatient and outpatient services, pharmacy, health assessment surveys, EPSDT, and targeted activities to ensure compliance with DHS contractual requirements.
  • Prepares reports and response to any DHS inquiry on members. Attends DHS onsite and external meetings.
  • Supports pediatric program implementation and evaluation. Reviews and analyzes data trends and reporting of pediatric initiatives.
  • Supports pediatric quality metrics and goals.
  • Focus on importance of health equity and social determinants of health in pediatric care.
  • Coordinate care management interventions for medical and behavioral health services, and social support needs, to help in meeting established Department goals, including all levels of care such as inpatient, outpatient, in-home, personal care, and skilled nursing facilities.
  • Works in collaboration with appropriate health plan departments and network providers/physicians, applying competent clinical knowledge and skills to achieve quality outcomes.
  • Collaborates with department management and staff, and product managers to develop and implement approaches that will assist in meeting product goals.
  • 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 all contacts with staff, health plan members, providers, peers, and visitors.
  • Represent clinical areas internally and externally for Medicaid member-related meetings or activities.

Qualifications

  • Bachelor's Degree in nursing, social work, public health administration, or other healthcare-related field from an accredited college or university required; master's level preferred
  • Five years of clinical experience, preferably Medicaid focused
  • Three years of managed care experience
  • Care Management experience, preferably Medicaid focused
  • Experience in managing staff in day to day activities
  • Experienced project management skills
  • Healthcare program management experience preferred.
  • Ability to analyze data, and organize multiple projects and tasks.
  • Detail-oriented individual with excellent organizational skills.
  • High level of oral and written communication skills
  • Proficiency with MS Office products


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct