Professional Care Manager

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

UPMC in Pittsburgh is seeking a Care Manager to coordinate the clinical and financial plan for patients, guiding utilization management, discharge planning, and post-acute referrals with a multidisciplinary team.

The role emphasizes collaboration with providers, payers, and community resources to ensure appropriate care, regulatory compliance, and safe, high-quality outcomes across care transitions.

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.

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.