Professional Care Manager (RN) - UPMC Hamot
Posted on: September 15, 2019
UPMC Hamot is looking for a full-time Professional Care Manager to
coordinate the care plan for its patients.The Care Manager (CM)
coordinates the clinical and financial plan for patients. Performs
overall utilization management, resource management, discharge
planning and post-acute care referrals and authorizations. Works
with multi-disciplinary team in resource management, discharge
planning and care facilitation.
Healing is just one aspect of a hospital stay. For patients and
their families, there are many clinical opinions, specialist
referrals, treatment choices, and financial considerations at
play--navigating all of that can be a confusing and overwhelming
process. They need an advocate, someone who foresees their needs,
knows their options, and begins strategizing their way home from
the moment of admission.
An essential member of the care delivery team, you will apply your
own judgment and problem-solving skills to ensure each patient is
provided with efficient, quality care while minimizing risks,
delays, and unnecessary costs. You will work hand-in-hand with the
multidisciplinary team as well as internal and external providers
and agencies to execute a safe discharge and a clear path forward
for patients and their families, including plans for
self-management, at-home care, and post-acute referrals and
outreach, as needed.
The Professional Care Manager is a valued step in the UPMC nursing
career ladder, with opportunities for continued growth and upward
- Reviews medical record daily to ensure patient continues to
meet LOC requirements and that chart documentation supports LOC
determination. Works with Physician Advisor and Attending
Physicians to obtain necessary documentation to support current
LOC, alters LOC as needed and expedites discharge planning for
patients who no longer require hospital services.
- Collaborates with patients, caregivers, internal/external
healthcare providers, agencies and payers to plan and execute a
safe discharge. Re-evaluates and revises discharge plan as patient
clinical condition merits. Develops alternative/multiple discharge
plans in anticipation of patient need for post-acute services. Uses
InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home
Care, DME, etc.) and obtain all necessary payer authorizations for
post-acute care. Documents Freedom of Choice re: post-acute
- Serves as resource to clinical and finance teams for clinical
documentation requirements, level of care, insurance coverage
issues, specific payer and government policies and post-acute
services coverage and availability.
- Attends Department meetings and Corporate Care Management
Training sessions in order to maintain current knowledge of all
payer and regulatory requirements, UPMC CM policies and procedures,
community resources. Ensures compliance with all payer and
- Promotes patient safety. Supports CORE measures information for
- Takes leadership role in concurrent denial process. Works with
Care Management Director, Physician Advisor, Attending Physicians
and clinical team to obtain necessary information and documentation
to support LOC. Initiates acceptance of lower LOC when appropriate
with assistance from billing office. Obtains Consent to Appeal on
Behalf of Member on all cases with concurrent denial.
- Starts discharge planning on admission and ensures DC
documentation is completed and updated regularly. Proactively
identifies barriers to discharge and works with multi-disciplinary
team to expedite care, monitor length of stay (LOS) and facilitate
discharge. Addresses complex clinical and social situations
efficiently in order to avoid unnecessary delays in discharge.
Documents all Avoidable Days in CANOPY system.
- Performs clinical review on admission and/or continued stay
using InterQual criteria to determine appropriate level of care
(Inpatient, OBS, etc.) Obtains all necessary authorizations for
level of care including admission and continued stay. Follows
payer-specific requirements to obtain and document
- Graduate of approved school of nursing.
- Two (2) years of nursing experience required.
- BSN or related Bachelors degree preferred.
- Previous case management experience preferred.
- Knowledge of healthcare financial and payor issues
- Knowledge of state, local, and federal programs preferred
- Use of InterQual criteria preferred.
Licensure, Certifications, and Clearances:
Currently licensed as professional nurse in the Commonwealth of PA.
UPMC Corporate Care Management Training Certificate of Completion
required with 4-6 weeks of hire. UPMC approved Care Management
- Registered Nurse (RN)
- Act 33 with renewal
- Act 34 with renewal
- Act 73 FBI Clearance
UPMC is an equal opportunity employer.
Minority/Females/Veterans/Individuals with Disabilities
Salary Range: $23.61 to $40.42 / hour
Union Position: No
Associated topics: asn, bsn, hospice, intensive care unit, mhb,
nurse, staff nurse, surgery, transitional, unit
Keywords: UPMC, Erie , Professional Care Manager (RN) - UPMC Hamot, Healthcare , Erie, Pennsylvania
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