Easter Seals Jobs

UPMC Health Plan is hiring a Supervisor, Health Manager to support the Community Health Workers team. This role will predominantly work remotely, with travel required throughout Allegheny and surrounding counties and occasional onsite presence at Harbor Gardens located in Pittsburgh’s North Shore.

The Supervisor, Health Manager is the point person for the Community Health Workers and ensures continuity and coordination of care for Health Plan members with behavioral health illnesses, complex behavioral health needs, and management of their medical conditions. The Supervisor, Health Manager is responsible for the day-to-day oversight of case assignment and complex issues that arise as well as supervision of the Community Health Workers.

Responsibilities:

• Perform duties and responsibilities in accordance with the philosophy and standards of UPMC Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts.

• Assists in the development and revisions of programs, policies, and procedures.

• Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.

• Independent problem-solving based on sophisticated knowledge of in-plan services, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization.

• Provide reports on case management cases or activities as requested.

• Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and network providers.

• Preserve confidentiality of the member.

• Receives and responds to complex calls regarding requests for services or resolution of complex issues.

• Assumes responsibility for health plan member's access to in-plan and/or supplemental services as medically indicated.

• Ensure adequate staff coverage and phone coverage for all shifts as well as transition to afterhours clinical care.

• Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues.

• Supervise collection of information from members and health coaching staff concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures which improve the flow of services to members.

• Oversee performance of health managers and works with direct supervisor for administrative and clinical issues.

• Supervises behavioral health staff, which includes, but is not limited to: Monitors, coaches, and reports staff activity/productivity on a weekly, monthly, and quarterly basis Monitors and assists staff in problem-solving and managing case referrals and work flows Assists staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas Evaluates staff performance on an ongoing basis, completes timely EPRs, and initiates corrective action, as appropriate

• Participate in integrated care team meetings in a cross cultural environment to coordinate transitions of care, discharge planning, benefit coverage, conflict resolution and resource needs.

• Performs clinical reviews, service authorization and care coordination and oversight and supervision of other team members for all Health Plan members receiving services.

• Maintains an understanding of behavioral health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and behavioral health management policies and procedures.

• Serves as a resource to staff and other Health Plan departments to identify opportunities for improvements, quality of care concerns, barriers and root causes, and participates in the member complaint and grievance process.

• Masters' degree and Pennsylvania Licensure in health or human services field; OR licensed RN (BSN preferred)

• Five years of experience in behavioral health clinical, care coordination, and/or case management required.

• Three years of experience in a managed care environment preferred.

• General knowledge of best practices in behavioral health, emphasizing work with special needs populations and in provider systems

• Computer proficiency required.

• Experience with Excel and Access databases preferred.

• Excellent verbal and written communication and interpersonal skills required.

• Knowledge of community resources required Licensure, Certifications, and Clearances:

• Case Manager certification preferred

• Clinical Social Worker (CSW) OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR 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