RN Clinical Care Manager – Care Coordination & Education

UPMC; Wexford (Allegheny County); On-site; USD 75,000 - 95,000; Full time

Job summary

UPMC Health Plan is seeking a full-time Clinical Care Manager to support outpatient, home health, and case management services for Passavant-McCandless Family Medicine.

Role focuses on face-to-face member interaction, care planning, and collaboration with caregivers, PCPs, and providers to close care gaps and improve outcomes. Requires RN license and CCM / certifications within 2 years of hire.

Qualifications

• Minimum 2 years of experience in a clinical setting and case management nursing required.
• BSN 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.
• Excellent organizational skills.
• High level of oral and written communication skills.
• CPR required per AHA standards within 30 days of hire.
• CCM certification or approved clinical certification required (or must be obtained within 2 years of hire).
• Driver's License and Act 33/Act 34/Act 73 clearances are required.

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.
• Engage member to develop an individualized plan of care with their PCP that promotes healthy lifestyles and reduces ER visits and hospital readmissions.
• Coordinate and modify the care plan with member, caregivers, PCP, specialists, and other departments as appropriate.
• Review member's current medication profile and address adherence issues with the member and providers.
• Refer member for Comprehensive Medication Review as appropriate.
• Refer members to case management, health management, or lifestyle programs based on assessment data.
• Provide education materials or resources to enhance health/lifestyle knowledge.
• Schedule follow-ups after ER visits or hospitalizations.
• Identify trends for improvement based on member/provider interactions.

Skills

RN

Case management

CCM certification

BSN preferred

Education

RN license

BSN preferred

Job description

UPMC Health Plan is seeking a full-time Clinical Care Manager to support outpatient, home health, and case management services for Passavant-McCandless Family Medicine.

Role focuses on face-to-face member interaction, care planning, and collaboration with caregivers, PCPs, and providers to close care gaps and improve outcomes. Requires RN license and CCM / certifications within 2 years of hire.