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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

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

Senior Health Manager

Description

UPMC Health Plan is hiring a full-time Senior Health Manager. The team is based out of downtown Pittsburgh's US Steel Tower, however, this position will work remotely with in-person attendance for meetings as required. This position will work standard daylight hours, Monday through Friday. 

The Sr. Health Manager ensures continuity and coordination of care for Health Plan members with complex health needs. They provide mentorship to other social workers and assists with special projects as assigned. They will also assist supervisors with day-to-day operations, which may include duties such as assignment of referrals, case consultation and training.

The Sr. Health Manager is responsible for review of health plan services and assessment of member's barriers to care,
as well as actively working with providers and assessing members to ensure a safe and coordinated discharge from an
inpatient setting. Interacts daily with facility clinicians, physicians, and UPMC Health Plan care managers and Medical
Directors as part of the member treatment team. Coordinates with Health Plan case managers or health management
staff members to follow up after discharge from an inpatient setting. Provides guidance and assistance to providers and
members to ensure that health care needs are met through the delivery of covered services in the most appropriate
setting and cost-effective manner.

Responsibilities:

 

  • Provides members, providers, and other stakeholders with information concerning benefits and coverage, and provides accurate information to members and families. Receives and responds to complex calls regarding requests for services or resolution of complex issues.
  • Competently employs motivational strategies that encourage individuals to explore motivation for change, enhance readiness, and develop competence in the use of behavior change skills.
  • Reviews member health information and readiness to change and triages members to the appropriate health intervention.
  • Completes timely and accurate documentation in the clinical record including case notes, assessments, problems, goals and interventions.
  • Performs duties and responsibilities in accordance with the philosophy and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
  • Monitors and evaluates the effectiveness of care plans. Identifies gaps in service and makes recommendations for changes when indicated to provide the most clinically appropriate services.
  • Completes Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and Security Awareness.
  • Interfaces with and refers members to community-based resources and other supportive services as appropriate.
  • Assists supervisor with day-to-day operations, which may include duties such as assignment of referrals, case consultation and training.
  • Develops and coordinates an individualized care plan with the member, member's family, and/or providers to address barriers to care.
  • Performs care coordination for Health Plan members including consultation with health plan colleagues, participation in inter-disciplinary team meetings, and collaboration with providers. Coordination also entails assistance with transitions in care, discharge planning, and review of benefit coverage and resolution of other barriers to resources.
  • 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.
  • Assists with special projects as assigned.
  • Identifies and reports any clinical, utilization, provider or outcomes issues to supervisor and offers recommendations for improvement.
  • Provides reports on Utilization management cases or Member/Provider activities as requested
  • Preserves confidentiality of the member.
  • Identify potential quality of care concerns and never events and refers to health plan quality management department. Document all activities in the Health Plan's care management tracking system following Health Plan and internal department standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
  • Performs in accordance with system-wide competencies/behaviors.
  • Performs other duties as assigned.

 

Qualifications

  • Master's degree in human service field and Human Services Licensure OR Licensed Pennsylvania RN and five years of experience required (plus Bachelor's in Nursing preferred).
  • Three years of experience in clinical, care coordination, and/or case management required.
  • Two years of experience in managed care environment required.
  • Proficient in utilizing Provider/Member engagement strategies such as motivational interviewing.
  • Ability to proficiently interact with provider systems, physicians and other health care professionals is required.
  • Computer proficiency required.
  • Experience with Microsoft Office preferred.
  • Excellent verbal and written communication and interpersonal skills required.
  • Knowledge of community resources required.


Licensure, Certifications, and Clearances:

  • PA Licensure (as indicated above)
  • Case Manager or other relevant certification preferred
  • Licensure in other states as assigned



UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct