Clinical Care Manager (RN) - Passavant-McCandless

UPMC•Wexford, PA

10d

About The Position

UPMC Health Plan is hiring a full-time Clinical Care Manager to support its partnership with physician practices at Passavant-McCandless Family Medicine. The role offers standard daylight hours, Monday through Friday, with no evenings, weekends, or holidays. It is suited to nurses with backgrounds in outpatient care, home health, or case management who are interested in health insurance and face-to-face interaction in a medical office setting. The Clinical Care Manager coordinates care and provides health education to identified Health Plan members through collaboration with members, caregivers, and providers. The role identifies medical, behavioral, and social needs and barriers to care, then develops comprehensive care plans that address those barriers, close preventive-care gaps, and support chronic illness self-management in accordance with clinical standards. The manager coordinates with medical management staff, other departments, providers, community resources, and caregivers. Members are followed through face-to-face interactions in community settings, including hospitals, provider offices, homes, and other healthcare facilities.

Requirements

At least 2 years of experience in a clinical setting and case management nursing.
At least 1 year of health insurance experience.
Excellent organizational skills.
Strong oral and written communication skills.
Computer proficiency.
Case management certification or approved clinical certification required, or must be obtained within 2 years of hire to remain in the role.
CPR meeting AHA standards, including didactic and skills-demonstration components, required within 30 days of hire.
Automotive insurance.
Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR).
Certified Case Manager (CCM).
Driver’s license.
Registered Nurse (RN) license.
Act 33 clearance with renewal.
Act 34 clearance with renewal.
Act 73 FBI clearance with renewal.
Current licensure in the state where the facility is located, or a multistate license issued by a participating NLC state if the facility is in a state covered by the Nurse Licensure Compact. Employees working on an out-of-state NLC license who change residency to the facility’s state must apply for licensure there within 60 days.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
One year of experience in clinical care, utilization management, home care, discharge planning, and/or case management preferred.

Responsibilities

Assist members with transitions of care between healthcare facilities, including sharing clinical information and the plan of care.
Document activities in the Health Plan’s care management tracking system.
Engage members in developing individualized plans of care with their primary care providers to promote healthy lifestyles, close care gaps, and reduce unnecessary emergency-room use and hospital readmissions.
Coordinate and modify care plans with members, caregivers, primary care providers, specialists, community resources, behavioral health contractors, and other Health Plan and system departments as appropriate.
Review members’ medication profiles, identify medication-adherence issues, and address them with members and providers as necessary.
Refer members for Comprehensive Medication Review when appropriate.
Refer members to appropriate case management, health management, or lifestyle programs based on assessment data, and engage them in Beating the Blues or other education and self-management programs.
Provide appropriate educational materials or resources to improve members’ knowledge and skills related to health or lifestyle management.
Contact members with preventive-care gaps and help schedule required screenings or diagnostic tests with their providers.
Assist members in scheduling follow-up appointments after emergency-room visits or hospitalizations.
Follow plan standards and identify trends and opportunities for improvement based on interactions with members and providers.
Present or contribute to interdisciplinary complex case reviews, summarizing clinical and social history, healthcare resource utilization, and case-management interventions.
Update care plans after review and communicate recommendations to members and providers.
Conduct comprehensive face-to-face assessments of members’ medical, behavioral, pharmacy, and social needs.
Review UPMC Health Plan data and member electronic health record documentation as appropriate, and identify care gaps based on clinical standards.