Nurse Clinical Care Coordinator - CAS, UPMC Your Care

UPMC In-Home Services is looking for a Nurse Clinical Coordinator to support their UPMC Your Care team in the Monroeville area. This is a Monday through Friday position with daylight hours.

Purpose:
The Nurse Clinical Care Coordinator is responsible for the delivery of nursing assessment and evaluation within recognized standards of nursing practice, care coordination, and health education with identified Health Plan members through face-to-face collaboration with members and their caregivers and providers. Identifies members' medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists members in closing gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. Collaborates and facilitates care with member's primary care provider, UPMC Your Care Interdisciplinary Team, other departments, providers, community resources, and caregivers to achieve desired member outcomes throughout the continuum of care. Members are followed by face-to-face interactions in their community including the hospital, providers' offices, skilled nursing facility, home, or other health care facilities. Title and salary will be determined based on education and nursing experience for Sr. Professional Care Manager within the Community and Ambulatory Services Division.

Responsibilities:

• Provides direct patient care, evaluates outcomes, and adjusts nursing care process as indicated to ensure optimal member care.
• Conducts comprehensive face to face assessments that include a clinical assessment and treatment, a review of the member's medical, functional, behavioral, pharmaceutical, and social needs, including instrumental activities of daily living.
• Review UPMC Health Plan data and EMR data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.
• Reviews 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.
• Successfully engages member to develop an individualized plan of care in collaboration with their primary care provider and the interdisciplinary team that promotes symptom management, goals of care/advanced directives, healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital admissions/readmissions, and manages social determinants of health.
• Coordinates and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health, and other health plan and system departments as appropriate.
• Completes all necessary documentation which may include visit assessments, plan of treatment, verbal orders, and care coordination activities accurately and promptly in electronic documentation system while in the member's home and within regulatory standards.

• Data syncs (transmits) information same day.

• Leads the interdisciplinary team and assigns other interdisciplinary team members as appropriate to assist in the appropriate delivery of services as ordered on the plan of care to the member.

Qualifications:

• Case management nursing preferred.
• BSN preferred.
• Minimum 1 year of health insurance experience preferred.
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred.
• Excellent organizational skills.
• High level of oral and written communication skills.
• Excellent problem-solving skills, self-motivation, enthusiasm, and creativity required.
• Computer proficiency required.
  Licensure, Certifications, and Clearances:
• Case management certification or approved clinical certification preferred
• Automotive Insurance
• Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
• Driver's License
• Registered Nurse (RN)
• Act 33
• Act 34
• OAPSA

*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

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