Care Manager Associate (Hybrid) - Contract

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 52,000 - 70,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Disability insurance

401(k)

Paid Time Off

Job summary

UPMC Health Plan is seeking a Care Manager Associate to support members transitioning home after hospital or skilled nursing stays. You will work with a multidisciplinary team to address medical, behavioral health, and social determinants affecting health and well-being.

This role offers daytime hours in a hybrid structure with travel 50-75% across Allegheny and Westmoreland Counties; after orientation, remote work is possible when not in the community.

Responsibilities

• Review Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
• Assist clinical team with scheduling transportation, scheduling appointments, and tracking utilization.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Assist members with non-medical needs that affect health and access to care.
• Successfully engage member in developing an individualized plan of care in collaboration with the member’s care team.
• Document all activities in the Health Plan’s care management tracking system following Health Plan standards based on information obtained from interaction with members and providers.
• Recognize and demonstrate shared accountability in development of a care plan with the member/caregiver as well as the team members to ensure optimal outcomes.
• Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient’s health, wellbeing, safety and rights.
• Maintain an understanding of all health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and health management policies and procedures.
• Interfaces with and refers members to community-based resources and other supportive services as appropriate.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.

Job description

The Community Team is looking for a Care Manager Associate to assist UPMC Health Plan members out in the community by assisting in their transition home following a recent hospital or skilled nursing stay. This care management associate position is a great opportunity for someone who wants to get their feet wet in the mobile social work or community services fields by working collaboratively with an experienced group of multidisciplinary providers to address any medical, behavioral health, or social determinant of health needs that might be negatively impacting the member's health and well-being.

The Care Manager Associate will work daylight hours in a hybrid work structure, with minimum weekend, after hours, or holiday coverage as needed by the department.This is a flexible community-based position that requires travel approximately 50-75% of the time to hospitals, provider sites, and member residences within Allegheny and Westmoreland Counties.After the successful completion of orientation and training, this role is able to work remotely when not out in the community!

In collaboration with the clinical care management team, the Associate coordinates the appropriate support services and resources throughout the Community Services Team at UPMC Health Plan to facilitate effective care plans that achieve optimal satisfaction, and clinical, and financial outcomes along the defined continuum of care.

The Care Manager Associate works collaboratively within the Community Service Team to gain an understanding of clinical care/utilization management. The Associate collects or assists in the documentation of simple to moderately complex care management assignments. The Care Manager Associate supports the clinical staff with administrative tasks and functions. The position will include telephonic and face-to-face contact with members receiving services, family members and other stakeholders to engage in problem-solving and referral strategies; community-based services; and resources available to members.

The Health Plan Community Services Team is a multidisciplinary team that goes out into the community to address any physical or behavioral health conditions and/or social determinants of health needs that might be negatively impacting the health and well-being of their members. The Community Services team is composed of several smaller specialized teams that provide intense case management and mobile interventions to best serve the communities in which they live and work.

Strategic Consulting Partners (SCP) is an award-winning, woman-owned, minority, small business. As an SCP employee and team member, you will work as a contractor for UPMC to improve the health and well-being of the UPMC Health Plan members in our communities.

Benefits Available through SCP include:

• Medical insurance
• Vision insurance
• Dental insurance
• Disability insurance
• 401(k)
• Paid Time Off: 9 Holidays, 2 Floating Holidays, and PTO accrual beginning day one of employment

Responsibilities

• Review Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
• Assist clinical team with scheduling transportation, scheduling appointments, and tracking utilization.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Assist members with non-medical needs that affect health and access to care.
• Successfully engage member in developing an individualized plan of care in collaboration with the member’s care team.
• Document all activities in the Health Plan’s care management tracking system following Health Plan standards based on information obtained from interaction with members and providers.
• Recognize and demonstrate shared accountability in development of a care plan with the member/caregiver as well as the team members to ensure optimal outcomes.
• Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient’s health, wellbeing, safety and rights.
• Maintain an understanding of all health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and health management policies and procedures.
• Interfaces with and refers members to community-based resources and other supportive services as appropriate.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.