RN Clinical Care Manager – In-Home & Community Care

UPMC; Franklin (Venango County); On-site; USD 70,000 - 100,000; Full time

Job summary

UPMC Health Plan is seeking a full-time Clinical Care Manager to support care coordination and health education for members in the Franklin, Oil City, and Clarion area. The role requires RN background, 2+ years of clinical/case management experience, and PA licensure.

Daytime schedules with no evenings, weekends, or holidays. Responsibilities include transition of care, care planning with providers, medication review, and linkage to health programs.

Qualifications

• Minimum of 2 years of experience in a clinical setting and case management nursing.
• Minimum 1 year of health insurance experience.
• BSN preferred.
• 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.
• Licensure, Certifications, and Clearances:
• Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role)
• CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire)
• Certified Case Manager (CCM)
• Driver's License
• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal

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 procedures.
• 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 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 members to appropriate case management, health management, or lifestyle programs based on assessment data.
• 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.

Skills

RN

Case management

Health insurance experience

Organization skills

Communication skills

CPR

Driver's License

CCM/Care management certification

Education

RN license

BSN preferred

Job description

UPMC Health Plan is seeking a full-time Clinical Care Manager to support care coordination and health education for members in the Franklin, Oil City, and Clarion area. The role requires RN background, 2+ years of clinical/case management experience, and PA licensure.

Daytime schedules with no evenings, weekends, or holidays. Responsibilities include transition of care, care planning with providers, medication review, and linkage to health programs.