COVID-19 Vaccination Information

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 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

Lead Care Manager

  • Job ID: 282334324
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Western Maryland
  • Department: Care Coordinat
  • Location: 12500 Willowbrook Rd, Cumberland MD 21502
  • Union Position: No
  • Salary Range: $30 to $49.40 / hour

Description

Are you an experienced Nurse looking to take the next step in your career? The Care Coordination department at UPMC Western Maryland has the right fit for you as a Lead Care Manager!

This position is eligible for a generous sign-on bonus!

If you are an experienced nurse looking to join UPMC, apply now!
Sign-On Bonus Details:
 $6,000 with a 2-year work commitment.

This is a Monday - Friday dayshift position.


In addition to staff level care management responsibilities for unit specific population, the Lead Care Manager assists in the operational activities of staff in the Care Management Department including the facilitation of care and services to patients and families across the continuum of illness. Assists the Director with staff orientation, mentoring and other operational issues.

Responsibilities:

  • Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.).
  • Obtains all necessary authorizations for level of care including admission and continued stay.
  • Follows payer-specific requirements to obtain and document authorizations.
  • Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources.
  • Ensures compliance with all payer and government regulations.
  • Examines and implements strategies to reduce patient complications and resource consumption for the case managed patient population.
  • Can function independently and effectively to solve problems.
  • Appropriately refers problem cases to the director of care management and/or medical staff leadership for expedient action or problem resolution.
  • Assists in the daily activities of the Care Management staff including making adjustments to staffing assignments as indicated.
  • Participates in the development of division goals and objectives in conjunction with the hospitals mission, strategic priorities and performance improvement plan.
  • Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge.
  • Re-evaluates and revises discharge plan as patient clinical condition merits.
  • Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services.
  • Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care.
  • Documents Freedom of Choice re: post-acute services.
  • Facilitates the development of educational materials for the department including an orientation program, job specific competencies, and continuing education.
  • Audits and evaluates the daily activates of Care management staff including utilization review, discharge planning, documentation, and interdisciplinary rounds.
  • Takes leadership role in concurrent denial process.
  • Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC.
  • Initiates acceptance of lower LOC when appropriate with assistance from billing office.
  • Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.
  • Utilizes innovative strategies to meet patient care needs when the plan of care meets or exceeds health benefits coverage limitations.
  • Promotes patient safety.
  • Supports CORE measures information for JCAHO requirements.
  • Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
  • Starts discharge planning on admission and ensures discharge documentation is completed and updated regularly.
  • Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge.
  • Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge.
  • Documents all Avoidable Days in CANOPY system.
  • Participates in the development/revision of departmental policies and procedures.
  • Maintains and updates resource materials for staff.
  • Develops internal and external customer relationships (medical staff, employees, families, payer groups, etc.).
  • Identifies customer needs, develops systems to monitor satisfaction and develops plans to address areas of dissatisfaction.
  • Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.
  • Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
  • Acts as a mentor to staff to ensure departmental standards are met.
  • Provides input to the manager/Director in the evaluation of staff and participates in the performance review process.
  • Develops and maintains a positive working relationship with the medical staff and health care team.
  • Facilitates and arbitrates differences and disagreements.
  • Uses diplomacy and negotiation skills to mediate conflict and achieve team objectives.
  • Incorporates and promotes service excellence principles and strategies into daily work.

 

Qualifications

  • BSN/BS in related field
  • 3 years of experience required
  • 2 years of experience in Care Management, PLUS 1 year of experience in leadership OR 1 year of experience as Sr. Professional Care Manager


Licensure, Certifications, and Clearances:

  • UPMC approved Care Management certification required within one year of hire. 
  • Registered Nurse (RN)

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

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