- 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 health plan programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional 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 assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.
- Minimum of 2 years of experience in a clinical setting and case management nursing required.
- BSN 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.
- Excellent organizational skills, and ability to multi-task, and pivot as needed while working in a fast-paced environment highly preferred.
- 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 workspace required in the home office setting or the ability to work from a designated UPMC office location daily.
- Case management certification or approved clinical certification preferred
- Registered Nurse (RN)
- Act 34
-
Care Manager
2 days ago
Crossroads Treatment Centers Pittsburgh, United StatesCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. · Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat pat ...
-
Care Manager
1 day ago
Familylinks Pittsburgh, United StatesJob Type Full-timeDescriptionFor more than six decades, Familylinks has been dedicated to serving the diverse individuals and families of Western Pennsylvania. In the past year alone, we extended our care to over 9,000 people spanning all age groups, residing in various neighborh ...
-
Care Manager
2 days ago
Familylinks Pittsburgh, United StatesJob Type · Full-time · Description · For more than six decades, Familylinks has been dedicated to serving the diverse individuals and families of Western Pennsylvania. In the past year alone, we extended our care to over 9,000 people spanning all age groups, residing in various ...
-
Care Management Assistant
1 week ago
St. Clair Health Pittsburgh, United States Full timeCare Management Assistant · St. Clair Hospital · CARE MANAGEMENTPittsburgh, PAAdministrative/Clerical SupportFull Time, DaysPosted 03/15/2024Req # 6746 Summary · Provides administrative services to one or more of the following departments: Case Management, Infection Control, P ...
-
RN-Care/Case Manager
16 hours ago
Amedisys Pittsburgh, United StatesOverview · RN-Care/Case Manager · PRN Minimum 4 shifts/monthly 8a-4:30p (NO WEKENDS, HOLIDAYS OR ON CALL) · Are you a highly skilled and compassionate RN looking for a rewarding career as a recovery care coordinator ? If so, w e invite you to join the team at Allegheny Health Net ...
-
Nurse Care Manager
6 days ago
Northside Christian Health Center Pittsburgh, United StatesDUTIES/RESPONSIBILITIES- · Demonstrates appropriate judgment skills to be able to make independent clinical decisions in routine patient care matters · Ensures the safe, productive, and efficient operation of the clinic through timely and attentive administrative and clinical sup ...
-
Clinical Care Manager
2 weeks ago
University of Pittsburgh Medical Center Pittsburgh, United StatesAssist member with transition of care between health care facilities including sharing of clinical information and the plan of care. Document all activities in the Health Plan's care management tracking system following Health Successfully engage mem Clinical, Care Manager, Behav ...
-
Care Management Assistant
5 days ago
St. Clair Health Pittsburgh, United StatesSummaryProvides administrative services to one or more of the following departments: Case Management, Infection Control, Physician Quality Improvement Teams, and the Home Care Referral process. Performs moderately complex secretarial duties including business correspondence, and ...
-
Territory Manager, Primary Care
2 weeks ago
Hill-Rom Pittsburgh, United StatesReference #: JR This is where you save and sustain lives · At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You'll feel a sense of purpose throughout the organization, as we know our wo ...
-
Residential Care Incident Manager
1 week ago
Merakey Pittsburgh, United StatesAre you looking for an opportunity to advance your career while working with an extraordinary team? At Merakey, we put heart and soul into everything we do. We are seeking an Incident Manager to join our team at our program in Crafton, PA · Under the direction of the Administrato ...
-
Residential Care Incident Manager
2 weeks ago
Merakey Pittsburgh, United StatesExternal Description · Are you looking for an opportunity to advance your career while working with an extraordinary team? At Merakey, we put heart and soul into everything we do. We are seeking anIncident Managerto join our team at our program inCrafton, PA · Under the directi ...
-
Care Manager
3 weeks ago
Crossroads Treatment Centers Pittsburgh, United StatesCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. · Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat pat ...
-
Telephonic Care Manager
2 weeks ago
University of Pittsburgh Medical Center Pittsburgh, United StatesPresent 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 Care Manager, Behavioral Healt ...
-
Drug and Alcohol Case Manager-Pathway to Care
3 weeks ago
Renewal Inc Pittsburgh, United StatesDefinition · To provide a range of crisis assessments and case management services to individuals, families and others in the community seeking SUD treatment services. Essential Responsibilities will include phone triage and in-person triage making preliminary risk assessment. Fa ...
-
Territory Manager, Primary Care
2 weeks ago
Baxter Healthcare Corporation Pittsburgh, United StatesThis is where you save and sustain lives · At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You'll feel a sense of purpose throughout the organization, as we know our work improves outc ...
-
Care Manager
2 days ago
Crossroads Treatment Centers Monroeville, United StatesCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat patient ...
-
Care Team Manager
5 days ago
Senior Helpers of Southwest Pittsburgh Bethel Park, United StatesObjective:The Care Team Manager will provide oversight and management of the care team with primary focus on the care givers and their day-to-day management. · Reports to:Owner · Primary Responsibilities (including, but not limited to): · Coaching and behavior modification ses ...
-
Care Manager
3 weeks ago
Crossroads Treatment Centers Monroeville, United StatesCrossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. · Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat pat ...
-
Training for a nursing specialist
3 weeks ago
Aurora Innovations Duquesne, United StatesAt Duquesne, we prioritize the FUTURE. We prioritize YOU. What do YOU prioritize? Are you looking for a career working with people? A job with purpose and gratitude? Diverse opportunities for growth and advancement? Becoming a professional in health and medicine? A profession tha ...
-
Salesperson/Cashier with Representative Function
3 weeks ago
NebulaWorks Pittsburg, United StatesLocation: 30823 Garbsen | Contract type: Full-time, permanent | Job ID: 836846 · PENNY is part of the REWE Group and employs over employees in around 2,140 stores, 10 logistics locations, and the headquarters. In the PENNY team, we are strong together and treat each other with re ...
Telephonic Care Manager - Pittsburgh, United States - UPMC Life Changing Medicine
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
Are you an experienced nurse with a background in case management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking for you We are hiring a full-time Telephonic Care Manager to join the Home and Community-Based Services (HCBS) Command Team. The team is based out of downtown Pittsburgh, but team members may reside anywhere in Pennsylvania. This position will predominantly work standard daylight hours, Monday through Friday.
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. Title and salary will be determined based upon education and nursing experience for Sr. Professional Care Manager within the Insurance Services Division.
Responsibilities:
Licensure, Certifications, and Clearances:
*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
UPMC is an Equal Opportunity Employer/Disability/Veteran