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Clinical Navigator

Description

UPMC Health Plan is hiring a full-time Clinical Navigator to help support the Health Management Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position with some evening shifts. This role will predominately work remotely and will come into the office as needed. 

The Clinical Navigator functions as a health coach on the UPMC Health Plan's Clinical Navigation team, providing telephonic, virtual, and digital care triage and health coaching to members of the Health Plan. Occasional off-site events (e.g. Lunch N Learns, health fairs) will also be required. The Navigator is often the first clinical contact for members interacting with the Health Plan. Duties involve conducting overall health assessments, in-the-moment coaching sessions, stage of change identification, optimizing behavioral activation, and clinical triaging of members to Health Plan programs and community resources. In addition to assessment and triage, coaches will deliver targeted, one-time coaching sessions around a variety of health-related topics (e.g. stress management, basic diabetes care, increasing healthy steps, shared decision making, managing depression, finding a medical home etc.)

Responsibilities:

 

  • Provides members, providers, and other stakeholders with accurate information concerning benefits and coverage. Receives and responds to complex calls regarding requests for services or the resolution of complicated issues.
  • Performs care coordination for Health Plan members including consultation with health plan colleagues and collaboration with providers. Coordination may also include assistance with transitions in care, linkage to community resources, review of benefit coverage and resolution of other barriers to resources.
  • Reviews members' health information, service availability, barriers, and readiness; triages members to the appropriate health intervention based on those variables.
  • Identifies and reports any clinical, utilization, provider or outcomes issues to supervisor and offers recommendations for improvement.
  • Completes Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and Security Awareness. Preserves confidentiality of the member.
  • Identifies health behaviors, risk factors or other concerns that would potentially improve members' health if targeted for change. Engage members in collaborative development of a personalized behavior change plan to address risk factors, collaborating with member physicians or other caregivers as appropriate.
  • Competently employs engagement strategies that encourage individuals to explore motivation for change, enhance readiness, and develop competence in the use of behavior change skills.
  • Provides timely feedback to primary care physicians or other providers about members' progress toward health goals.
  • Utilizes independent problem solving and demonstrates ability to propose and implement creative solutions to member problems in order to achieve a high level of member satisfaction with services.
  • Reviews health risk assessment and health screening results with members, enhancing members' understanding of current risks and interventions that could mitigate risk.
  • Completes timely and accurate documentation of member contacts in the clinical record including case notes, assessments, etc. Provides reports on caseload or coaching activities as requested.
  • Provides one-time or on-the-spot coaching interventions for various health topics such as decreasing cholesterol, enhancing relationship with PCP, getting more active, managing symptoms of anxiety, etc. Offers support and coaching related to online/digital programs as well. May deliver other health and wellness programs based on employees' training and expertise.

 

Qualifications

  • Bachelor's degree in psychology, health education, nutrition, exercise physiology, counseling, social work, public health or a related field required.
  • Master's degree in human service field preferred.
  • Experience in counseling, clinical assessment, care coordination, coaching, and/or case management preferred.
  • Experience in managed care environment preferred.
  • Knowledge of, or ability to learn, client-centered counseling approaches that emphasize nonjudgmental empathic interaction and collaborative development and implementation of behavior change plans.
  • Proficient in utilizing member engagement strategies such as motivational interviewing.
  • Ability to proficiently interact with provider systems, physicians and other health care professionals is required.
  • Knowledge of community resources required.
  • Detail-oriented individual with excellent organizational skills.
  • Computer proficiency required.
  • Experience with Microsoft Office preferred.
  • Ability to learn new computer-based documentation skills.
  • Excellent verbal and written communication and interpersonal skills required.


Licensure, Certifications, and Clearances:

  • Licensed staff may be asked to obtain additional state licenses as needed.


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct