Clinical Care Manager - Maternity - Northwestern Pennsylvania (RN) Job
Job Description Job Attributes+
UPMC Health Plan
Medical Mgmt Medicaid
600 Grant St, Pittsburgh, PA 15219, US
Full-Time - Regular
8 a.m. to 4:30 p.m.
29.22 - 49.32 / HOUR
The Clinical Care Manager will work to identify members' medical, behavioral, and social needs and barriers to care. You will develop a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. You will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by face to face interactions in their community including the hospital, providers' offices, home, and other health care facilities.
- 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
- 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. 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. Engage members in the Beating the Blues or other education or self management programs. 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. 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.
- Minimum of 2 years of experience in a clinical and/or 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.
- OB or maternity nursing experience highly preferred.
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
- Automotive Insurance
- Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
- Driver's License
- Registered Nurse (RN)
Who We Are
<p>At UPMC, we're all here for the same reason - to provide outstanding care. From nursing to finance, pharmacy to software development, each of us contributes in our own way, in our own career path. </p><p>We encourage growth through leadership development, skill building, and continuing education, so that employees can explore their interests and define their careers, while always playing a part in life changing medicine. And, while our opportunities vary, we remain united by the same values across our system:
</p><ul><li>Quality & Safety</li><li>Dignity & Respect</li><li>Caring & Listening</li><li>Responsibility & Integrity</li><li>Excellence & Innovation
</li></ul><p>If you too are driven by these values, we’re ready for you. Find your ideal job at UPMC today!</p>