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Manager, Care Management

Description

Are you interested in working at Magnet-designated UPMC Magee-Womens Hospital? Only 7% of hospitals nationwide have achieved Magnet designation… and we’re one of them! For more than a century, UPMC Magee has been caring for patients through all stages of their lives, and we are looking for the next talented employee to join our team.

We are hiring a Full-timeManager, Care Management to support our Case Management. 

This position will work daylight hours with 24 hour accountability for work performed by department, occasional weekends and on-call. Hours are subject to change based on business needs.

The Manager oversees the day-to-day operations of the Care management department under the direction of the Director. The Manager is accountable for the following Care Management functions: training, auditing, systems support: Care Management Technology, InterQual, Concurrent Denials and reporting. Leads efforts to develop, implement, evaluate, redesign and modify Care Management practice standards. Works closely with the CM staff in an effort to safely, effectively and efficiently move patients across and through the continuum of care.

Responsibilities:

  • Develops reporting tools to assist CM Director and executive leadership teams to assess the effectiveness of CM efforts.
  • Collaborates with other UPMC departments to establish mechanisms to address issues related to care management, tracks, trends avoidable day/delay documentation and reports to Director trends/barriers.
  • Analyzes data for trends related to variation in actual vs. targeted length of stay.
  • Collaborates with other staff to develop performance improvement activities as indicated.
  • Oversees daily operations of the Care Manager (CM) staff under the direction of the Director of Care Management.
  • Conducts employee performance reviews.
  • Utilizes identified denial trends to develop training tools to facilitate maximum financial reimbursement.
  • Monitors and mentors Care Management staff.
  • Develops and implements processes for timely and accurate documentation of appropriate data relating to concurrent denials.
  • Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators.
  • Coordinates with CM in an effort to meet the established length of stay targets.
  • Coordinates with CM staff to ensure safe/effective/efficient plans of care are implemented
  • Conducts inter rater reliability audits per established policy.
  • Ensures training programs address identified needs of CM staff
  • Assists with management of departmental budget.
  • Collaborates with CM Director, Medical Director/Physician Advisor and staff to ensure effective processes and systems are established and maintained to meet department goals.
  • Participates in leadership development.
  • Functions as a resource person for the care management and denial management processes.
  • Coordinates daily flow of the department (this includes overseeing PTO requests, assignment coverage, weekend coverage)
  • Takes a leadership role in the mentoring and monitoring of documentation expectations in Care Management technology.
  • Analyzes data for trends and causative factors that promote or impede progression toward positive care management outcomes.

 

Qualifications

  • MSN/MS in related field OR enrolled within 1 year of hire & complete within 3 years of enrollment
  • 3 years of experience required in Care Management
  • 1 year of experience in leadership required
  • Medical/Surgical or OB nursing experience preferred. 
  • Knowledge of the discharge planning process and home health resources preferred. 

Licensure, Certifications, and Clearances:

  • Current Nursing Licensure in the Commonwealth of Pennsylvania.
  • UPMC approved Care Management certification or agreement to obtain upon hire required.
  • Behavioral Dimensions:
    • Current knowledge of medical care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization/case management, discharge planning, Medicare, Medicaid, and other third-party payor requirements, and managed care principles preferred.
    • Use of expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care among all health care providers while maximizing use of resources is required.
    • The ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action is required.
    • Expertise in interpersonal relationships, organizational relations, and effective communication, negotiation, and conflict resolution skills are required.
    • The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required.
    • Strong sense of commitment and of being in control of one’s practice is needed. Ability to effectively resolve practice issues and facilitates practice changes within the organization and throughout the continuum of care is required.
    • Ability to foster principles of participative management by identifying/involving relevant individuals in program-related decisions is required.
    • Ability to apply creative and innovative approaches to develop and maintain systems that achieve higher levels of multi-disciplinary team performance and desired patient outcomes is needed.
  • Registered Nurse (RN)
  • 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