RN Clinical Care Manager: Outpatient & Home Health

UPMC; Pittsburgh (Allegheny County); Sur place; USD 60 000 - 85 000; Plein temps

Résumé du poste

UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with physician practices in the Shadyside area. The role focuses on transition of care, care coordination, and individualized care planning with primary care providers to improve health outcomes and reduce unnecessary ER visits and readmissions.

The position follows standard daylight hours, Monday through Friday, with no evenings, weekends, or holidays, offering direct interaction with members in a medical

Responsabilités

• 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 standards.
• 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 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 member for Comprehensive Medication Review as appropriate.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Provide members with 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.
• Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
• Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
• Present or contribute to complex case reviews 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.
• Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member.
• Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.

Description du poste

UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with physician practices in the Shadyside area. The role focuses on transition of care, care coordination, and individualized care planning with primary care providers to improve health outcomes and reduce unnecessary ER visits and readmissions.

The position follows standard daylight hours, Monday through Friday, with no evenings, weekends, or holidays, offering direct interaction with members in a medical