Remote Telephonic Care Manager - Nurse Case Management

UPMC; Pittsburgh (Allegheny County); Remote; USD 65,000 - 90,000; Full time

Job summary

UPMC Health Plan seeks a Telephonic Care Manager to join the Home and Community-Based Services (HCBS) Command Team. This full-time role will primarily operate remotely during standard daylight hours, Monday through Friday, coordinating care for health plan members via telephone and electronic communication.

The position involves identifying medical, behavioral, and social needs, developing comprehensive care plans, and collaborating with members, caregivers, and providers to close gaps in

Responsibilities

• Present complex members for review 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.
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.
• Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary.
• Refers member for Comprehensive Medication Review as appropriate.
• Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member.
• Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
• Refer members to appropriate health plan programs based on assessment data.
• Engage members in education or self-management programs.
• Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management.
• 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.
• Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
• Document all activities in the Health Plan's care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
• Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.

Job description

UPMC Health Plan seeks a Telephonic Care Manager to join the Home and Community-Based Services (HCBS) Command Team. This full-time role will primarily operate remotely during standard daylight hours, Monday through Friday, coordinating care for health plan members via telephone and electronic communication.

The position involves identifying medical, behavioral, and social needs, developing comprehensive care plans, and collaborating with members, caregivers, and providers to close gaps in