Professional Care Manager, Supervisor (RN) - Pittsburgh

Professional Care Manager, Supervisor

UPMC Health Plan is seeking a full-time Professional Care Manager, Supervisor to join our Utilization Management (UM) Clinical Operations team. This position follows a MondayFriday daylight schedule, with a rotating Saturday on-call shift once per month. While primarily remote, candidates must reside in the Pittsburgh area to ensure availability for occasional in-office team meetings and collaboration.

The Supervisor is responsible for oversight and day-to-day care coordination functions for telephonic, clinical, or utilization management care management staff, including the direct supervision, coaching and counseling of staff. Monitors staff workload, assignments, and productivity. Assists care managers with problem solving with complicated member cases. Acts as a resource for staff and other departments within the Health Plan. Facilitates orientation and on boarding for clinical staff and mentors staff in order to achieve departmental goals. Contributes or completes performance reviews for staff.

Responsibilities:

• Ensure staff receives, understand and adhere to applicable regulatory/compliance guidelines related to their departmental expectations (I.E. NCQA, DPW, CMS).
• Conduct regularly scheduled team and individualized meetings to communicate information, ongoing education and/or individual performance feedback.
• Serve as a resource to staff and other Health Plan departments to identify opportunities for improvements, quality of care concerns, and barriers to care coordination. Utilize evidence based practice to support improvement in care / health / utilization management.
• Monitor, coach and report staff productivity and adherence to regulatory and work flow standards. Manage staff schedules to ensure that departmental goals are met.
• Contribute to the development, implementation and annual review of departmental policies and procedures.
• Participate in interdisciplinary treatment team meetings to facilitate the development of appropriate and comprehensive plans of care. Assist staff in making referrals to community or governmental agencies.
• Collect data, validate data where possible, prepare reports and assist teams in analysis and monitoring of key utilization targets and trends.
• Facilitate staff orientation and on boarding for new staff. Monitor staff participation in mandatory education and competency assessment requirements at the system, Health Plan, and department level.
• Assess staff member's ability to engage members and provide coaching to increase the use of motivational techniques. Complete performance evaluations within departmental timeframes.
• Contribute to the development, implementation, and evaluation of clinical programs within the team or department. Assist with integrating HP programs across the Health System and vendors as needed.

Qualifications:

• Bachelor's degree in nursing or related field required

• 2 years of nursing experience required

• 4 years of care manager experience required
• Prior UM experience is a bonus.
• Two years of supervisory or leadership experience preferred.
• Case management certification or approved clinical certification within one year of hire or 1 year health plan management experience required
• Ability to analyze data and monitor trends required
• Managed care experience preferred
• Proficiency with Microsoft Office products
• Excellent interpersonal and communication skills (verbal and written); Ability to collaborate effectively with physicians and other health care professionals
• Strong organizational and problem solving skills with ability to make decisions independently
• Ability to develop and maintain effective team-focused working environment
• Licensure, Certifications, and Clearances:
• Case management certification or approved clinical certification within one year of hire or 1 year health plan management experience required
• Registered Nurse (RN)
• Act 34

*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