Pittsburgh, Pennsylvania, United States · Remote OK
UPMC Health Plan is hiring a full-time UM Care Manager to join the UM Clinical Operations team. This role will work remotely, daylight hours EST, Monday through Friday. The Utilization Management (UM) Care Manager is res…
Skills: Utilization Review, Case Management, Clinical Assessment, Discharge Planning, Medical Necessity Review
Pittsburgh, Pennsylvania, United States · Hybrid
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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Pittsburgh, Pennsylvania, United States · On-site
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The UM Care Manager performs utilization reviews and assessments to ensure members receive cost-effective care in the most appropriate setting. They coordinate safe discharge transitions from inpatient settings by collaborating with providers, physicians, and medical directors.
Requires a Registered Nurse (RN) license and at least two years of clinical or case management nursing experience, including one year in Utilization Management. Prior psychiatric experience and case management certification are strongly preferred.
UPMC Health Plan is hiring a full-time UM Care Manager to join the UM Clinical Operations team. This role will work remotely, daylight hours EST, Monday through Friday.
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care, as well as actively working with providers and assessing members to ensure a safe and coordinated discharge from an inpatient setting. Interacts daily with facility clinicians, physicians, and UPMC Health Plan care managers and Medical Directors as part of the member treatment team. Facilitates transitions in care for skilled nursing, rehabilitation, long term acute care, as needed. Coordinates with Health Plan case managers or health management staff members to follow-up after discharge from an inpatient setting. Provides guidance and assistance to providers and members to ensure that health care needs are met through the delivery of covered services in the most appropriate setting and cost - effective manner.
Responsibilities:
*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.
UPMC is an Equal Opportunity Employer/Disability/Veteran
Life Changing Medicine.
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
Offices: US Steel Tower, 600 Grant Street, Pittsburgh, PA 15219, US
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