Clinical Care Manager (RN) - Erie

About the role

The Clinical Care Manager supports the partnership between UPMC Health Plan and various physician practices, focusing on outpatient, home health, or case management settings. This role works in the Erie area, with standard daytime hours.

Responsibilities

• Aid members in transitioning care between health care facilities, sharing clinical information and care plans.
• Develop and implement individualized care plans for members, collaborating with primary care providers and other stakeholders.
• Review and address medication adherence issues, referring members to Comprehensive Medication Reviews as needed.
• Refer members to appropriate case management, health management, or lifestyle programs, and educate them on managing their health.
• Contact members with gaps in preventive care services and assist them in scheduling necessary screenings or diagnostic tests.
• Conduct comprehensive face-to-face assessments to identify gaps in care and trends, presenting findings to interdisciplinary teams.
• Present complex case reviews, updating care plans and communicating recommendations to members and providers.

Qualifications

• Minimum 2 years of clinical experience and case management nursing required.
• Minimum 1 year of health insurance experience required.
• Bachelor of Science in Nursing (BSN) preferred.
• Experience in clinical, utilization management, home care, discharge planning, or case management preferred.
• Excellent organizational and communication skills.

Requirements

• Certified Case Manager (CCM) or equivalent certification required.
• CPR certification required.
• Licensed as a Registered Nurse (RN).
• Clearances: Act 33, Act 34, Act 73 FBI clearance.