Description

UPMC Health Plan is hiring a full-time Mobile Professional Care Manager to support the Community Team. This is a Monday through Friday daylight role. This is a community-based position and will require travel throughout Westmoreland and Indiana counties. This role will work remotely when not traveling.

The Mobile Professional Care Manager assists UPMC Health Plan members who require care coordination and conducts assessments that include behavioral, clinical, social, and environmental concerns or needs. Members will be followed in their community, place of residence, and in facilities. The Mobile Professional Care Manager will coordinate programs, services, and facilitate communication between the member's physicians, physical and behavioral health clinicians, and community-based services.

Responsibilities:

• Conducts face-to-face member assessments by visiting the member in the member's community, place of residence, or facility. Conduct on-site hospital coordination for discharge planning with facility staff if needed. Coordinate with member's physicians to ensure follow-up and coordination of care
• Collaborates with providers and others in order to obtain initial assessment, treatment planning and aftercare planning for members.
• Conducts member assessments identifying behavioral, clinical, social, and environmental concerns and needs.
• Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans.
• Ensures that cases are managed and documentation is within established timeframes in accordance with departmental standards. Participates in case conferences, interagency and provider treatment planning and departmental meetings.
• Makes referrals and provides expertise regarding community and governmental agencies.
• Assesses member's knowledge of their clinical condition and the need for further education
• Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members.
• Develops specific outreach plans for assigned members who do not maintain regular contact with their medical or behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care.
• Receives and responds to complex and crisis calls.
• Coordinates care and services across the continuum of care with case management, physicians, pharmacy, behavioral health, and other providers or health plan departments as appropriate.
• Identifies barriers to care and develops specific integrated plan of care in collaboration with the member, family, provider, and UPMC Health Plan staff.
• Maintains contact with and refers members to community based case management services as appropriate. Identifies provider issues and recommendations for improvement. Demonstrates knowledge of clinical treatment, case management and community resources.

Qualifications

• Pennsylvania Licensure in health or human services field and master's degree OR licensed RN (BSN preferred)
• Three years of experience in behavioral, clinical, utilization management, home care, discharge planning, and/or case management required.
• Five years of experience with community-based case management, and behavioral health experience preferred.
• General knowledge of best practices in working with special needs populations in the public sector preferred.
• Detail-oriented with excellent organization skills required. High level of oral and written communication skills required.
• Proficiency in Microsoft Office products is preferred and ability to learn new software applications required.
• Three years experience in a managed care environment preferred
• For RN's - Case management certification or clinical certification preferred (or obtained within 2 years of hire)

Licensure, Certifications, and Clearances:

• Act 33 Child Clearance w Renewal
• Act 34 Crim Clearance w Renewal
• Act 73 FBI Clearance
• Automotive Insurance
• Basic Life Support OR Cardio Pulmonary Resuscitation
• Driver's License
• CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
• Clinical Social Worker (CSW) OR Licensed Marriage & Family Therapist OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR Psychologist OR Registered Nurse (RN)
• For RN's - Case management certification or clinical certification preferred (or obtained within 2 years of hire)

UPMC is an Equal Opportunity Employer/Disability/Veteran