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Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Nurse Liaison/Case Manager (RN) - Medical Oncology

Description

Purpose:

UPMC Hillman Cancer Center is currently hiring for a Regular Full-Time Nurse Liasion/Case Manager (RN) to work with the Hillman Cancer Center in Shadyside/Pittsburgh, PA.  This position will work a Monday through Friday daylight schedule supporting the 3rd Floor Medical Oncology team of the Hillman Cancer Center.  This position will offer a $6,000 sign-on bonus.

The incumbent Initiates the clinical management effort in coordination with multi-disciplines in order to effectively influence the attainment of desired clinical outcomes. Promotes a collaborative healthcare intake process and facilitates proper allocation of resources. 

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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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