Clinical Care Manager (RN) - Oncology Nurse Navigator

Socket.dev; Pittsburgh (Allegheny County); Hybrid; USD 75,000 - 95,000; Full time

Job summary

UPMC Health Plan is seeking a full-time Clinical Care Manager (RN) - Oncology Nurse Navigator to join a multidisciplinary team for discharge planning and case management. The role is hybrid with at least two days onsite at Hillman Cancer Center.

The ideal candidate has 2+ years of clinical and case management experience, Oncology experience preferred, and RN licensure. Strong organization, communication, and computer skills are required to support preventive care and care transitions.

Qualifications

• Requires 2+ years clinical setting and case management nursing experience.
• Oncology experience strongly preferred (2+ years).
• 1 year health insurance experience required.
• Experience in clinical/utilization management, home care, discharge planning, or case management preferred.

Responsibilities

• Assist members with transition of care between facilities and share plan of care.
• Document activities in care management tracking system and maintain records.
• Develop individualized care plans with PCP collaboration to improve health and reduce readmissions.
• Coordinate care plan with member, caregivers, PCP, specialists, and health plan departments.
• Review medication profiles, address adherence issues and refer for Comprehensive Medication Review as needed.
• Refer members to case management or health management programs and provide education materials.

Skills

Clinical experience

Case management

Oncology experience

Insurance experience

Discharge planning

Organization

Communication

Computer proficiency

Education

RN license

BSN preferred

Job description

Purpose

UPMC Health Plan is hiring a full-time Clinical Care Manager (RN) - Oncology Nurse Navigator to work as part of a multidisciplinary care team providing Oncology discharge planning and case management support.

This role is Hybrid and will work Monday-Friday, standard daylight hours with a minimum of 2 days onsite at UPMC Hillman Cancer Center.

Responsibilities

• Assist 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 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.
• Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
• Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in the Beating the Blues or other education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.
• Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
• Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
• Present or contribute to complex case reviews 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.
• Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member.
• Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.

Qualifications

• Minimum of 2 years of experience in a clinical setting and case management nursing required.
• Minimum of 2 years of Oncology experience highly preferred.
• Minimum 1 year of health insurance experience required.
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred.
• BSN Preferred.
• Excellent organizational skills.
• High level of oral and written communication skills.
• Computer proficiency required.

Licensure, Certifications, and Clearances

• Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role)
• CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
• Automotive Insurance
• Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
• Certified Case Manager (CCM)
• Driver's License
• Registered Nurse (RN)
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal

*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.

Equal Opportunity Employer

UPMC is an Equal Opportunity Employer/Disability/Veteran