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   Current UPMC employees must apply in HR Direct

Nurse Liaison/Case Manager (RN) - Medical Oncology/Stem Cell Transplant

Description

Purpose:

UPMC Hillman Cancer Center is currently hiring for a Care Manager/Nurse Liasion (RN) to support the Hillman Cancer Center team in Pittsburgh/Shadyside, PA.  It will have a Monday through Friday daylight schedule with Work From Home capabilities after training and work commitments.  

This position will support the authorization needs of the Hillman Cancer Center, with a focus on stem cell transplant workups. The role includes but is not limited to obtaining authorizations for radiology imaging, oncologic and supportive medications, testing, inpatient, and prework-up transplant cases.

Responsibilities:

  • Adapt quickly to changing conditions, assimilating new processes into job functions and taking ownership.
  • Display effective time management and organizational skills to identify, prioritize and reach goals and objectives faster and easier, cope with multiple demands in a timely manner, and overcome changing priorities.
  • Maintain knowledge of SI/IS criteria for commercial, Medicare, and Medicaid insurance products.
  • Interpret insurance contract guidelines and expectations and make recommendations for compliance.
  • Actively live and demonstrate University of Pittsburgh Medical Center Health System core values.
  • Communicate and work with physicians, physician office personnel, associates, case managers, third party payer review personnel, and others in order to expedite the intake/utilization review process to avoid negative financial impact on the facility.
  • Serve as a change agent, coach, mentor, team builder and facilitator.
  • Maintain strict confidentiality within and outside the organization.
  • Interpret third party payor contract requirements and recommend, design and implement procedures for compliance with regulations and standards.
  • Possess self-motivated spirit and seek educational opportunities to increase professional competency.
  • Interpret complex medical data to analyze applicability of review criteria to ensure optimal patient care while maximizing reimbursement.
  • Use knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.
  • Maintain creativity in making process recommendations.
  • Serve as a role model to others.
  • Display dynamic communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers.
  • Assist in the design and implementation of a program that elicits desired outcomes on an organizational level.
  • Handle a high degree of pressure, heavy workloads, multiple requests, numerous interruptions, and short deadlines in a positive manner, establishing priorities for effective work completion.
  • Effective critical thinking, problem solving and decision making skills.
  • Demonstrate patient assessment skills and knowledge of patient acuity levels.
  • Successfully plan, monitor, support and improve multiple activities.
  • Negotiate with insurance vendors, medical directors, and third party payors when appropriate in order to facilitate the delivery of care in the most appropriate setting.

 

Qualifications

  • Bachelor's Degree from an accredited school of nursing/allied health preferred.
  • 3-5 years of progressive nursing in an acute care setting with at least one (1) year of experience in utilization review or managed care required.
  • Previous authorization experience and strong interpersonal skills with knowledge of behind the scenes insurance processes and coding is preferred
  • Extensive knowledge of clinical symptomology and related treatment required.
  • Knowledge of 3rd party payer review criteria.
  • Patient assessment skills and knowledge of patient acuity levels.


Licensure, Certifications, and Clearances:
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
 

  • Registered Nurse (RN)
  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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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