Remote RN Care Manager – Telephonic Health Coordinator

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 70,000 - 95,000; Full time

Job summary

UPMC Health Plan is seeking a Telephonic Care Manager to support the Medicare Case Management team. This primarily remote role will involve coordinating care, educating members, and collaborating with caregivers and providers to close gaps in preventive care and manage chronic illness.

The position requires engagement with members by phone, documentation in the health plan tracking system, and coordination with PCPs, specialists, and community resources.

Responsibilities

• Present complex members for review by the interdisciplinary team.
• Update the plan of care following review and communicate recommendations to the member and providers.
• Contact members with gaps in preventive health care and assist scheduling tests.
• Review medication profiles; address adherence issues with members and providers.
• Refer members for Comprehensive Medication Review as appropriate.
• Conduct comprehensive assessments of medical, behavioral, pharmacy, and social needs.
• Review plan data to identify care gaps based on standards of care.
• Refer members to appropriate health plan programs based on assessment data.
• Engage members in education or self-management programs.
• Provide education materials to enhance health and lifestyle management.

Job description

UPMC Health Plan is seeking a Telephonic Care Manager to support the Medicare Case Management team. This primarily remote role will involve coordinating care, educating members, and collaborating with caregivers and providers to close gaps in preventive care and manage chronic illness.

The position requires engagement with members by phone, documentation in the health plan tracking system, and coordination with PCPs, specialists, and community resources.