Clinical Account Manager (RN) - Hybrid

UPMC•Pittsburgh, PA

9h•Hybrid

About The Position

UPMC Health Plan and WorkPartners are hiring a Clinical Account Manager to join the Population Health team. The team is headquartered in downtown Pittsburgh at the U.S. Steel Tower. This position will work in a hybrid model, with a few in office days each week – Monday, Wednesday and Thursday. This position provides the necessary support, supervision, and direction to assigned large accounts related to clinical results and findings for the specific account membership. This position differs from a traditional Account Manager role in that it involves minimal client-facing responsibilities. While there may be periodic client engagement, the majority of the work will be centered on partnering with the analytics team and internal UPMC stakeholders.

Requirements

Diploma in nursing from an accredited nursing program required.
2 years of experience in the managed care/insurance field.
Prior experience analyzing claims data strongly preferred.
Strong Leadership and Interpersonal skills.
Excellent organizational and presentation skills.
Clinical analytical skills.
Familiarity interpreting and applying population risk scores
Expert skills utilizing self-service reports.
Excellent oral and written communication skills.
Proficiency in Microsoft Office including Word, Power Point and Excel.
Registered Nurse (RN)
Current 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. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

Responsibilities

Collaborate with Data Analyst to receive reports according to schedule.
Analyze and understand the clinical issues driving client account's trends.
Prepare recurring custom high-cost claimant reports for large and strategic accounts.
Collaborate with key clinical areas of health plan to identify areas of opportunity for clinical management improvements.
Act as key team member of Large Market Account Management.
Coordinate with clinical areas of the health plan to understand results.
Prepare with Data Analysis team account reports.
Present results to account on scheduled basis - represents the clinical arm of the health plan.
Participate in health plan Clinical Account Management team meetings- is the lead for assigned accounts.
Conduct clinical and financial analysis of reports Clinical leadership and Account Management teams.
Respond to ad-hoc inquiries and requests from acct management
Act as ongoing liaison to account for all clinical matters - acute, chronic and preventive care initiatives.
Develop project and clinical initiative plan for each account.
Participate in the development of Department policies and procedures.