Care Manager - Behavioral Health

UPMC•Pittsburgh, PA

12h•Onsite

About The Position

UPMC is searching for a full-time Care Manager to oversee UPMC McKeesport Behavioral Health. This position will work out of an office at UPMC Western Psychiatric Hospital- 3811 O'Hara Street in Oakland. This Care Manager is responsible for inpatient/ambulatory workflows and day-to-day operations at McKeesport, while working offsite. Shifts will be primarily Monday-Friday, 8am-4pm. Preference is given to candidates with exposure to behavioral health settings as well as experience with insurance. The Care Management team offers experienced employees to help train and support new hires, with opportunities to grow and promote to higher levels of the Care Management career ladder, earning more money along the way.

Requirements

Bachelor's degree in Human Services or related field with 3 years of clinical experience/healthcare experience
OR licensed RN with BSN with 3 years of clinical experience/healthcare experience
OR Master's degree in Human Services/related field with 1 year of clinical experience/healthcare experience
Current Registered Nurse (RN) licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state

Nice To Haves

Care Management experience
Behavioral Health experience
Exposure to behavioral health settings
Experience with insurance

Responsibilities

Maintain a thorough understanding of Care Management processes as established by industry standards.
Gather and maintain current patient progress from the medical record and treatment team meetings.
Complete Care Management reviews according to established medical necessity criteria.
Complete Care Management reviews within payer timelines.
Document pertinent clinical information on the Care Management Abstract.
Complete accurate, timely, and thorough documentation in electronic applications (e.g., HealthPlaNET, EPIC).
Demonstrate proficiency in IT applications/portals (e.g., HealthPlaNET, Cerner, EPIC, payor portals).
Effective communication with WPH management team regarding authorization challenges.
Coordinate MD-MD reviews with the MDs and Care Management administrative staff.
Assist with the appeal process (e.g., creating and updating denial tracking sheets).
Participate in telecons, grievance hearings, and DHS pre-hearings/hearings as needed.
Assist with the resolution of billing questions and/or denials.
Develop and sustain collaborative working relationships with other WPH departments (e.g., Patient Access, PES, PC+, Fiscal) as well as with external insurers.
Display effective problem-solving skills.
Demonstrate effective communication skills both verbal and written.
Display a positive attitude, be a helpful team member.
Participate in departmental improvement projects.
Proficiency in Microsoft Office applications.
Perform in accordance with system-wide competencies/behaviors.
Complete other related duties as assigned.