Clinical Care Manager: Discharge & Care Coordination

UPMC; Pittsburgh (Allegheny County); On-site; USD 65,000 - 95,000; Full time

Job description

The Care Manager coordinates the clinical and financial plan for patients. Care Managers perform overall utilization management, resource management, discharge planning and post-acute care referrals and authorizations while with multi-disciplinary team in resource management, discharge planning and care facilitation.

Responsibilities

• Evaluates patient records and applies InterQual criteria to ensure appropriate level of care and authorization compliance.
• Coordinates discharge planning, post-acute services, and transitions of care with patients, providers, payers, and community resources.
• Collaborates with interdisciplinary teams to address barriers, manage denials and appeals, and optimize length of stay.
• Ensures compliance with regulatory, payer, and organizational requirements while promoting patient safety and quality outcomes.
• Serves as a clinical resource for documentation, coverage determinations, and care management processes.

Qualifications

• Graduate of approved school of nursing.
• BSN preferred.
• Two years of nursing experience required.
• Previous case management experience preferred.
• Knowledge of healthcare financial and payor issues preferred.