May 20, 2012

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Case Manager – Medicaid (Pittsburgh, Pennsylvania)

February 27, 2012 By

Contact:
UPMC Health Plan
Pittsburgh, PA
1-866-918-1595

Case Manager-Medicaid
1061750
68121
HPLAN-Medical Mgmt Medicaid
UPMC Health Plan
The UPMC Health Plan is the second-largest health insurer in western Pennsylvania, and has been one of the fastest-growing health plans in the United States. As part of an integrated health care delivery system, UPMC Health Plan partners with UPMC and community network providers to improve clinical outcomes and the health of the greater community.
Full-Time
Regular
Job Summary
The UPMC Health Plan is seeking a full-time case manager for our Medicaid Medical Management Department located in downtown Pittsburgh.  The case manager ensures continuity and coordination of care for UPMC Health Plan Medicaid members with catastrophic illnesses and complex medical needs.  The case manager works 9 am to 5:30 pm Monday through Friday or as needed.
Responsibilities
-Perform duties and responsibilities in accordance with the philosophy and standards of the UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
-Contact potential case management members to determine if there is a need for case management intervention.
-Develop and coordinate an individualized treatment plan with the member, member’s family, and providers.
-Follow-up with the member according to established timeframes to monitor their care to assess whether quality care is being provided in an appropriate setting.
-Evaluate the effectiveness of the treatment plan and identify gaps in service.  Make recommendations for changes when indicated.
Basic Qualifications
-Three years of experience in clinical, utilization management, home care, discharge planning, and/or case management required.
-Three years of experience in a managed care environment preferred.
-Ability to interact with physicians and other health care professionals in a professional
manner required.
-Must be able to work in a rapidly changing work environment.
-Must be able to manage competing priorities and be an expert multitasker.
-Computer proficiency required.  Experience with Access databases preferred.
-Excellent verbal and written communication and interpersonal skills required.
Licensure/Certifications
-Valid Pennsylvania RN licensure required.
-Bachelor’s degree in nursing preferred.
-Case Manager Certification preferred.
22.89
30.51 38.13
UPMC is an equal opportunity employer.
Filed Under: JOBS