[Hiring] Behavioral Health UM Care Manager (RN) @UPMC

Role Description

UPMC Health Plan is hiring a part-time UM Care Manager to join the UM Clinical Operations team. This role will work remotely, with scheduled hours falling between 8:00 AM and 4:30 PM EST, Monday through Friday.

The Utilization Management (UM) Care Manager is responsible for:

• Utilization review of health plan services
• Assessment of member's barriers to care
• Working with providers and assessing members for safe and coordinated discharge from inpatient settings
• Interacting daily with facility clinicians, physicians, and UPMC Health Plan care managers and Medical Directors
• Facilitating transitions in care for skilled nursing, rehabilitation, long term acute care, as needed
• Coordinating with Health Plan case managers or health management staff for follow-up after discharge
• Providing guidance and assistance to ensure health care needs are met in a cost-effective manner

Responsibilities include:

• Reviewing and documenting clinical information from health care providers
• Conducting clinical reviews for authorization requests using established criteria
• Working closely with peers and other departments to determine discharge needs
• Obtaining documentation to support requested level of care
• Maintaining communication with health care providers regarding health plan determinations
• Participating in interdisciplinary team conferences and collaborative case reviews
• Identifying potential quality of care concerns and referring to quality management department
• Documenting all activities in the Health Plan's care management tracking system

Qualifications

• Minimum of 2 years of experience in a clinical and/or case management nursing required
• BSN or MSN strongly preferred
• Prior UM experience strongly preferred
• Prior psych experience strongly preferred
• PA RN license strongly preferred
• Work experience of 1 year in discharge planning preferred
• Strong organizational, task prioritization and problem-solving skills
• Ability to construct grammatically correct reviews using standard medical terminology
• Computer proficiency required

Requirements

• Case management certification or approved clinical certification preferred
• Registered Nurse (RN)
• Act 34 clearance
• Current licensure in the state where the facility is located or a multistate license issued by a participating NLC state

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.