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Telephonic Care Manager (RN) - Pediatric

  • Job ID: 254038932
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8 am to 4:30 pm
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Medical Mgmt Medicaid
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $28.33 to $47.73 / hour

Description

Are you an experienced Pediatric nurse with case management experience? We have a unique opportunity that may be a perfect fit for you! UPMC Health Plan is hiring a full-time Telephonic Care Manager to work with families, members, nursing agencies, and providers to identify medical, behavioral, and social needs for pediatric Health Plan members. 

This position will be predominantly working from home and will work standard daylight hours, Monday through Friday with the occasional evening shift as needed. The team is based out of downtown Pittsburgh, but team members may reside anywhere in Pennsylvania.


The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Identifies members' medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. Collaborates and facilitates care with other medical management staff, other departments, providers, community resources, and caregivers to provide additional support. Members are followed by telephone or other electronic communication methods.

Responsibilities:

 

  • Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.
  • Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.
  • Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate.
  • 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.
  • Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
  • Successfully engage members to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with members, caregivers, PCP, specialists, community resources, behavioral health contractors, and other health plan and system departments as appropriate.
  • Document all activities in the Health Plan's care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
  • Conduct member outreach in response to requests from employer groups, community, and/or governmental agencies to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.

 

Qualifications

  • Minimum of 2 years of experience in a clinical setting and case management nursing required.
  • BSN preferred.
  • Ability to interact with physicians and other health care professionals in a professional manner required.
  • Excellent verbal and written communication and interpersonal skills required.
  • Computer proficiency required.
  • Pediatric nursing experience highly preferred.
  • Home health experience preferred.
  • Pennsylvania RN license preferred.

Licensure, Certifications, and Clearances:

  • Case management certification or approved clinical certification preferred
  • Registered Nurse (RN)

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 — 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.

   Current UPMC employees must apply in HR Direct