Case Manager

University of Pittsburgh Physicians are hiring a full-time Case Manager to join their team at UPMC Montefiore Hospital in Oakland, PA! In this position, you will assist gender-affirming and young adult patients with complex medical histories aging out of pediatric care and seen through the Progressive Evaluation and Referral Center (PERC). You will work Monday-Friday during daylight hours. No evenings, weekends or holidays required! 

Purpose:
The Case Manager ensures continuity and coordination of care for members/patients with care coordination, health care education, and self-management needs. The Case Manager identifies member/patient barriers and whole person needs of the members/patients including medical, behavioral, pharmaceutical and social needs. Develops a comprehensive care plan that includes prevention, member/patient self-management education, and clinical standards of care. Coordinates with other medical management staff, other departments, providers, members/patients, and care givers to provide additional support to the members/patients.

Responsibilities:

• Provide case management according to program descriptions including member/patient education, follow up on a timely basis and eliminating barriers to care.
• Successfully engage member/patient to develop an individualized plan of care to promote healthy lifestyles, close gaps in care, reduce unnecessary ER utilization and hospital readmissions. Develop and coordinate the individualized plan of care with the patient, patient's family, providers and community agencies as applicable. Involve other staff to support the individualized plan of care based on identified needs of the patient.
• Based on assessment of patient's needs and environment, identify applicable barriers, problems, goals, and interventions that will address those needs and improve or maintain the health status of the patient.
• Follow-up with the patient according to established clinical program protocols and timeframes to monitor their status, evaluate the effectiveness of the individualized plan of care, and identify new needs. Modify the individualized plan of care or case status based on the status of the patient.
• Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the patient. Review UPMC Health Plan and EMR data for services the patient has received and identify gaps in care based on clinical standards of care.
• Perform duties and responsibilities in accordance with the philosophy and standards of UPMC, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, patients, peers, and external contacts.
• Outreach to patients, families, and referring providers, including coordinating the intake process
• Create and maintain a database of PERC patients.
• Complete forms and paperwork including Family Medical Leave Act (FMLA) forms for parents, annual physical exam forms required by personal care homes and insurance companies, power-of-attorney (POA), medical-decision-maker (MDM), and guardianship paperwork as well as waivers to pay for caregiver services. 
• Assist with scheduling appointments with specialists or for health maintenance and referring patients to community resources such as CLASS and the Health Law Clinic. 
• Assist with prior authorization for durable medical equipment (DME), medications, and procedures. Complete DME orders including writing letters of medical necessity along with medication reconciliation and refills, especially post-hospitalization.