Clinical Care Manager (RN) - Passavant-McCandless

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

Job summary

UPMC Health Plan is hiring a full-time Clinical Care Manager to support care coordination and health education for identified members through face-to-face interactions with members, caregivers, and providers in outpatient, home health, or case management settings. This role emphasizes closing gaps in preventive care and helping members manage chronic illness.

Work hours are standard daylight, Monday through Friday, with no evenings, weekends, or holidays, and duties include documenting

Qualifications

• Nursing background required.
• Interest in health insurance and in-person member interaction.

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 Plan standards.
• Engage member to develop an individualized plan of care in collaboration with their primary care provider; promote healthy lifestyles and reduce ER utilization.
• Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, and other departments.
• Review member's medication profile; address adherence issues with member and providers.
• Refer member for Comprehensive Medication Review as appropriate.
• Refer members to case management, health management, or lifestyle programs; engage in Beating the Blues or similar programs.
• Provide education materials or resources to enhance health or lifestyle management.
• Contact members with gaps in preventive care and help schedule screenings or tests.
• Assist member to schedule follow-up after ER visits or hospitalizations.
• Plan standards and identify trends for improvement from member/provider interactions.
• Present or contribute to complex case reviews summarizing history and resource use.
• Update care plan based on reviews and communicate recommendations.
• Conduct comprehensive face-to-face assessments covering medical, behavioral, pharmacy, and social needs.
• Review Health Plan data in the member's EHR and identify gaps in care.

Skills

Nursing background

Job description

Purpose:

Are you looking for an opportunity to use your nursing background in outpatient, home health, or case management? Do you have an interest in health insurance, but thrive on working in a medical office setting with face-to-face interaction with the members you are caring for?

UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with various physician practices. This role will support locations of Passavant-McCandless Family Medicine. The position will work standard daylight hours, Monday through Friday with no evenings, weekends, or holidays!

The Clinical Care Manager is responsible for care coordination and health education with identified Health Plan members through face to face 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 face-to-face interactions in their community including the hospital, providers' offices, home, and other health care facilities.

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.