Job DescriptionJob Title: Mobile Clinical Care Manager (RN) - Maternity - Flexible Location
Job ID: 726794500
Shift: Day Job
Department: Medical Mgmt Medicaid
Are you an experienced OB or Maternity nurse with a familiarity with care management or home health? Do you have an interest in making a difference within the communities you consider home? We have a unique opportunity and we are looking for you!
UPMC Health Plan is hiring a full-time Clinical Care Manager to support our Maternity Program. This position will provide face-to-face care coordination and health management in the selected candidate's surrounding communities. Mileage reimbursement is offered.
This position can be based out of Northwestern, Southwestern, or Central Pennsylvania dependent upon the selected candidate's location. This position will work daylight hours, Monday through Friday.
The Maternity Program at UPMC Health Plan is offered to women enrolled in our insurance products. Experienced maternity nurses serve as health coaches throughout the continuum of a woman's pregnancy, including the post-partum period. The program is designed to identify pregnant members, assess member needs, and develop coordinated care plans centered on the member's needs and the member's input.
In this role, you will reinforce provider education related to health pregnancy behaviors, identifying modifiable risk factors, educate the member about changes in health conditions that may require provider follow up, and linking the member with appropriate community resources to support both mom and baby during the post-partum period.
The Clinical Care Manager will work to identify members' medical, behavioral, and social needs and barriers to care. You will develop a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. You will collaborate and facilitate care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by face to face interactions in their community including the hospital, providers' offices, home, and other health care facilities.
- Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care.
- Document all activities in the Health Plan's care management tracking system following Health
- 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 ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
- Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.
- Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. Engage members in the Beating the Blues or other education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
- Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
- Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
- Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.
- Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.
Minimum of 2 years of experience in a clinical and case management nursing required.
Minimum 1 year of health insurance experience required.
1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred.
- OB or maternity nursing experience highly preferred.
Home visitation experience highly preferred.