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   Current UPMC employees must apply in HR Direct

Team Lead - Care Management | Western Psychiatric Hospital

Description

Purpose:
The Team Lead of Care Management at Western Psychiatric Hospital is responsible for workflow and day-to-day operations of the designated team members. This responsibility includes Care Manager staff oversight to ensure that they complete the duties of a care manager in a timely, clinically effective, and courteous manner. The Team Lead is responsible for the recommendation of policies and procedures pertaining to team functions and for monitoring team operations consistent with those policies, as well as for the inpatient care management work processes related to obtaining authorizations for inpatient hospitalizations and managing prospective denials as well as appeal activity.

Responsibilities:

  • Assist staff to ensure that all clinical reviews are consistent with medical necessity criteria.
  • Provide training for new Care Managers.
  • Coordinate adequate Care Manager coverage for team.
  • Work collaboratively with other internal departments to improve services, provide quality outcomes, and implement policies and procedures.
  • Organize meetings, maintain minutes, and implement results from management meetings.
  • Assist with coverage for the department when the Manager is off.
  • Maintain responsibility for a designated caseload.
  • Assist Manager with monitoring performance of care managers.
  • Maintain strong communication within the team as well as with leadership and senior management regarding clinical/fiscal outcomes and external stakeholder processes.
  • Participate in internal and external meetings to support ongoing knowledge of current clinical services, medical necessity criteria, and Care Management applications.
  • Monitor the completion of Physician Reviews.
  • Maintain responsiveness to deadlines and unplanned demands as required by the team.
  • Demonstrate and apply knowledge for all levels of care in facilitating problem resolution and/or comprehensive Care Management processes.

Qualifications

  • Master's degree in health service field or licensed RN with BSN.
  • 4 years of clinical experience in behavioral health service systems.
  • 5 years of work experience in managed care strongly preferred.
  • Demonstrate leadership qualities within behavioral health field preferred.
  • Strong working knowledge of managed care functional areas, including terms and definitions.
  • Sound clinical judgment and independent problem solving based on, care management policies and the operating practices of the organization.
  • Ability to propose and implement creative solutions to problems.
  • Excellent clinical written and oral communication skills.
  • Time flexibility with responsiveness to deadlines and unplanned work activities.
  • Knowledge of community resources and specialized behavioral health services.


Licensure, Certifications, and Clearances:

  • Act 31 Child Abuse Reporting with renewal
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct