Description

UPMC Health Plan is hiring a full-time Associate Health Care Manager to support the Population Health team. This role will work standard daylight hours, Monday through Friday, and will predominately work remotely. Preference will be given to candidates located in Western Pennsylvania. A Bachelor's degree in Social Work or a related field is preferred.

In collaboration with the Clinical Care management team, the Associate coordinates the appropriate support services and resources throughout UPMC Health Plan to facilitate effective care plans that achieve optimal satisfaction, clinical, and financial outcomes along the defined continuum of care. The Associate Health Care Manager works collaboratively with various care management departments within UPMC Health Plan to gain an understanding of clinical care/utilization management. The Associate Health Care Manager collects or assists in the documentation of simple to moderately complex care management assignments. The Associate Health Care manager supports the clinical staff with administrative tasks and functions.

Responsibilities:

• Perform duties and responsibilities in accordance with the philosophy and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.
• Assist clinical teams with securing transportation, scheduling appointments, tracking utilization management delays with prior auth and durable medical equipment.
• Conduct assessments that include the medical, behavioral, and social needs of the member as follow up to a member's Health Assessment Survey.
• Review Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers.
• Review member's current medication profile: identify issues related to medication adherence, and address with the member and providers as necessary.
• Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ED utilization and hospital readmissions.
• Document all activities in the Health Plan's care management tracking system following Health Plan standards based on information obtained from interaction with members and providers.
• Recognize and demonstrate shared accountability in development of a care plan with the patient/member/caregiver as well as with team members to ensure optimal outcomes.
• Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient's health, well-being, safety, and rights.
• Maintains an understanding of all health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and health management policies and procedures.
• Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
• Interfaces with and refers members to community based resources and other supportive services as appropriate.
• Contact potential case management members to determine if there is a need for case management intervention.

Qualifications

• A Bachelors degree in social work or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of those being served. No license required. A diploma or associates degree nurse. Preference will be given to those with a bachelor's degree in social work or related field.
• Managed care experience preferred.
• Ability to interact with other health care professionals in a professional manner required.
• Computer proficiency required.
• Experience with Microsoft office products preferred.
• Excellent verbal and written communication and interpersonal skills required.
• Knowledge of community resources preferred.
• Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement.
• This position works on a recorded line
• Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily.
  

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran