Telephonic Care Manager- Community HealthChoices

UPMC Health Plan's Community HealthChoices team is looking for a Telephonic Care Manager to join the team! Community HealthChoices (CHC) is Pennsylvania's managed care long-term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid. This is a remote position and does not require any travel. This position will primarily be responsible for managing a Participant caseload and providing episodic care management and resources to CHC Participants. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan Participants through telephonic collaboration with Participants and their caregivers and providers. Identifies medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists Participants to close gaps in preventive care, addresses barriers to care, and supports the Participant’s self-management of chronic illness based on clinical standards of care. Collaborates and facilitates care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Participants are followed by telephone or other electronic communication methods. Responsibilities: Contact participants with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the participant. Review UPMC Health Plan data for services the participant has received and identify gaps in care based on clinical standards of care. Refer participants to appropriate health plan programs based on assessment data. Engage participants in education or self-management programs. Provide participants with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. Successfully engage participant 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. Coordinates and modifies the care plan with participant, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. Document all activities in the Health Plan's care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with participants and providers. Conduct participant outreach in response to assist with participant issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns. Minimum of 2 years of experience in a clinical setting and case management nursing required. Experience with Service Coordination in the community and nursing facility settings strongly preferred Experience with leading interdisciplinary teams to facilitate and support discharge planning and managing transitions of care strongly preferred Excellent understanding of Medicaid, Medicare, and LTSS waiver programs strongly preferred BSN preferred. Ability to interact with physicians and other health care professionals in a professional manner required. Excellent verbal and written communication and interpersonal skills required. Computer proficiency required. 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. 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: Case management certification or approved clinical certification preferred 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 Apply To This Job