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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

Telephonic Care Manager (RN) - Adult Case Management (Job Share - Part Time Hours)

  • Job ID: 220001GT
  • Status: Job Share
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Commercial Clinical CM
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $29.18 to $49.16 / hour

Description

Are you an experienced nurse looking for the next challenge in your career? Do you have knowledge of case management
 or care coordination? Check out this fantastic new opportunity! UPMC Health Plan is hiring a Telephonic Care Manager Job Share position to support our Commercial Products Care Management team based in our office located in Downtown Pittsburgh. This position will be predominantly working from home with occasional evenings and weekends required. 

The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Identifies members' medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based
 on clinical standards of care. Collaborates and facilitates care with other medical management staff, other departments,
 providers, community resources and caregivers to provide additional support. Members are followed by telephone or other
 electronic communication methods 

 


Responsibilities: 


- Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare
 resource utilization, case management interventions. Update the plan of care following review and communicate
 recommendations to the member and providers. 
- Contact members with gaps in preventive health care services and assist them to schedule required screening or
 diagnostic tests with their providers. 
- Review member's current medication profile; identify issues related to medication adherence, and address with the
 member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate. 
- Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member.
 Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical
 standards of care. 
- Refer members to appropriate case management, health management, or lifestyle programs based on assessment
 data. Engage members in the Beating the Blues or other education or self management programs. Provide members
 with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle
 management. 
- Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider
 that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions.
 Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral
 health contractor, and other health plan and system departments as appropriate. 
- Document all activities in the Health Plan's care management tracking system following Health Plan standards and
 identify trends and opportunities for improvement based on information obtained from interaction with members and
 providers. 
- Conduct member outreach in response to requests from employer groups, community and/or governmental agencies to
 assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to
 resolve issues or concerns.

Qualifications

- Minimum of 2 years of experience in a clinical setting and case management nursing required. 
- BSN preferred. 
- CDCES preferred. 
- Compact nurse license preferred 
- Ability to interact with physicians and other health care professionals in a professional manner required. 
- Excellent verbal and written communication and interpersonal skills required. 
- Computer proficiency required. 
- Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. 
- Equipment must be connected directly or hard wired to the internet modem/router with an ethernet cable. Most cable and
 fiber optic providers can meet the requirement. 
- Private, secure designated work space required in the home office setting or the ability to work from a designated UPMC
 office location daily. 


Licensure, Certifications, and Clearances: 


- Case management certification or approved clinical certification preferred 
- Registered Nurse (RN) 


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