UPMC Health Plan

Title: Behavioral Health Therapist II Location: Harrisburg United States Job Description: Job ID: 7827089458 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Hybrid Facility: Pinnacle Health Medical Services – Specialty Department: CAC Home Cost Center Location: 2645 North Third Street, Harrisburg, PA Union Position: No Salary Range: $ 32.75-49.2 USD UPMC is seeking a dedicated Behavioral Health Therapist II to join the Child Advocacy Center in Harrisburg, PA. This role provides trauma-informed therapy services to children, adolescents, and adults impacted by trauma. - Deliver trauma-informed, evidence-based therapy to patients served by the Child Advocacy Center - Provide services to children, teens, and adults who have experienced trauma - Maintain a flexible schedule, including availability for at least six appointments after 3:30 PM - Manage an independent caseload and scheduling within a Monday–Friday, 40-hour workweek - Opportunity to work up to 16 hours per week remotely Cover letter strongly preferred with application Purpose: The purpose of this job is to be part of a collaborative care team that provides behavioral health assessments and treatment to service patients who have a behavioral health diagnosis. This level of service can be an outpatient treatment program or equivalent to outpatient (e.g., primary care office, partial hospitalization). Responsibilities: - Maintains daily records of clinical productivity in the program as instructed. - Provides individual and group therapy to patients in the program(remove word program) home, school, community settings and engages families in the assessment and treatment processes when indicated. Provides education to patients on recovery as appropriate. - Participates in regular treatment team meetings to discuss clinical cases, review and update patient treatment plans, monitor therapeutic progress and initiate recommendations for referral and continuing care. - Utilizes a relevant and evidence based treatment approach in the context of the program as appropriate. - Conducts assessments of new patients using the identified format for documentation and clinical decisions regarding treatment, interventions and referrals, as instructed. Implements, improves, and adapts concepts, models, and constructs of treatment for application in service delivery to patients. - Creates a treatment plan that includes an effective continuum of therapeutic, supportive and other services for the patients a variety and complexity of needs serviced by the program. - Participates in the regulatory and licensure preparation activities on an ongoing basis with program leadership. - Independently demonstrates competency in management of administrative responsibilities associated with patient care with minimal supervision. This may include but not be limited to caseload management, group census, and other administrative tasks. - Documents all assessments, treatment sessions, contacts, case management and other work done on behalf of patients according to guidelines. - Grows clinical skills by learning and implementing new treatment approaches on a regular basis. - Reviews cases and/or groups periodically, as well as serious clinical patient condition changes with supervisor and other clinical personnel as indicated. - Completes clinical documentation on the same day of service delivery and provides clinical information to patient access representative personnel and insurance providers to ensure authorization for services. - Participates in the mentoring of student interns. - Participates in the quality assurance and performance improvement activities of the program. - Assesses changing needs of patients per guidelines for outpatient, and/or partial hospitalization programs, community and school based programs, and incorporates these into treatment plan and treatment plan review. - Discusses need for additional services with the clinical team to determine appropriateness of recommendations. Refers patients to other levels of care, community based self-help programs for recovery or other community social or human services as needed. Qualifications: - Master’s degree in Psychology, Social Work, Counseling, School Counseling, or a related field required. - Minimum of two (2) years of clinical experience diagnosing and treating behavioral and psychiatric conditions required. - Demonstrated knowledge of psychiatric evaluation and assessment processes, including application of the current Diagnostic and Statistical Manual of Mental Disorders (DSM) required. Licensure, Certifications, and Clearances: Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) or Licensed Marriage Family Therapist (LMFT) or Clinical Social Worker (CSW) is required. - Clinical Social Worker (CSW) OR Licensed Certified Social Worker (LCSW) OR Licensed Marriage & Family Therapist OR Licensed Professional Counselor (LPC) - Act 31 Child Abuse Reporting with renewal - Act 33 with renewal - Act 34 with renewal - Act 73 FBI Clearance with renewal UPMC is an Equal Opportunity Employer/Disability/Veteran

Title: Senior Clinical Pharmacy Specialist (Remote- Must be licensed in PA! Location: Remote PA, United States Job ID: 7928940840 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: UPMC Health Plan Department: PHARMACY SRVCS Union Position: No Salary Range: $ 51.48-87.36 USD Job Description: UPMC Health Plan has an exciting opportunity for a Senior Clinical Pharmacy Specialist in the Pharmacy Services department. This is a remote position working Monday through Friday daylight hours. Registration as a registered pharmacist (RPh, in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required. The Senior Clinical Pharmacist must demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed. In addition to consistent, exceptional performance, the Senior Pharmacist must have already demonstrated their initiative and ability to work independently. This role will have completed several stretch projects as outlined by their manager. The stretch projects, in addition to all new projects, would then be the ongoing responsibility of the Senior Pharmacist to manage. This may include but is not limited to, training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives. Additionally, the Senior Clinical Pharmacist will assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs. This role is responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks. Responsibilities: - The Senior Clinical Pharmacist must demonstrate multiple years of being a consistent, high-performing team member as measured by both volume and quality of work performed. In addition to consistent, exceptional performance, the Senior Pharmacist must have already demonstrated their initiative and ability to work independently. This role will have completed several stretch projects as outlined by their manager. The stretch projects, in addition to all new projects, would then be the ongoing responsibility of the Senior Pharmacist to manage. This may include but is not limited to, training other staff, actively participating and contributing solutions in strategic discussions, assisting with internal and external audits, and creating and assisting with workflow improvement and efficiency initiatives. Additionally, the Senior Clinical Pharmacist will assist in finding new clinical, quality, and efficiency improvements through the management of the Formulary, Prior Authorization, and other clinical programs. This role is responsible for the successful and satisfactory completion of additional projects that are beyond their day-to-day tasks. - The Product Development Pharmacist is responsible for: Assisting with clinical management of the designated line of business (Commercial, Exchange, Medicare, Medicaid, Exchange, and/or CHIP from a pharmacy formulary and operational perspective and for understanding and complying with rules and regulations affecting the business. Develop and revise various formularies for each line of business including sending communications, training of identified departments, updating all brochures, updating appropriate websites, and submitting change forms. Review new drugs promptly and submit change forms as appropriate. Research adequately and be properly prepared for all P&T Committee meetings, ensuring all recommendations for both new drugs and new policies are appropriate and have been discussed with subject matter experts. Present these assignments succinctly and at a suitable pace and answer relevant questions. - Provide innovative ideas for new and existing clinical program development, utilization management, formulary management, provider education, and therapeutic substitution programs. Work with employer clients, account management, and sales in meetings as assigned to improve the understanding of the pharmacy benefit, as well as offering recommendations. Additional responsibilities for the Sr Pharmacist include: - Administrative Participate in meetings, committees, and work groups both internally and externally as assigned. Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS, and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions. Communication Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to members, employer groups, and providers. Develop communication materials to providers, including discussions regarding formulary changes/adherence, health education, medication compliance, and trend management. - Teaching and Education Mentor students and assist in precepting for the residency program if applicable. Assists in the training of pharmacy personnel. - Special Skills/Ability to Interact: Have the ability to function independently, but support team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness in completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers, and clients. Honor client and patient confidentiality. Qualifications - Internal - Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D. from an accredited U.S. School of Pharmacy. - Experience in pharmacy benefit management, insurance, managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs. - One year of experience in a managed care pharmacy setting. - Effective communication skills, both written and oral. - Must have strong analytical ability and organizational skills. - Computer literacy for pharmacy programming, word processing, data management. - Assessment of job-related skills and competency will be reviewed annually via daily functioning, job-related documentation, department-based competency programs, and continuing education activities. Licensure, Certifications, and Clearances: Registration as a registered pharmacist (RPh, in home state. Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board.

Title: Data Specialist-Imaging (Float Location: Pittsburgh United States Job ID: 7742063753 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: University of Pittsburgh Physicians Department: 60198 POP21 RAD Community Admin Union Position: No Salary Range: $ 20.0-30.55 USD Job Description: UPP Radiology has an exciting opportunity for those with experience or interest in Imaging! The incumbent to this fully remote position will be joining a high-performing team which provides quality service in the interest of improving patient care and outcomes through facilitating communications and workflows for onsite and remote Radiologists in the Clinical Division. Although remote, this position will be highly interactive with fellow team members, Radiologists, and other health care providers and staff and requires personable and professional communication over various channels (phone, messaging, email. The ideal candidate will have prior experience in an imaging department or as a Registered Technologist. Comfortability with technology, including working within and switching between multiple applications is necessary. This is a float position that will be responsible for covering all shifts as needed (primarily 2p-10:30p when not covering morning or night shifts. Responsibilities: - Maintain accurate and up to date physician data in the Radiology Information system for report distribution. - Maintain imaging reports by adding assessment and recommendations. - Review/Run reports checking for exams without dictation and send information back to the radiologist for review when clinically indicated. - Under direction of the Director/Manager, performs short- and long-term audits. - Act as liaison between the department, as well as other departments to acquire patient information. - Review data and completes statistical analysis utilizing various software programs. - Maintain data essential to conduct an annual mammography medical audit in compliance with the Mammography Quality Standards Act (required when position is within the Breast Imaging Dept OR Maintain data essential to re-accreditation for ACR and AIUM (required when position is within the Radiology and Ultrasound Departments. - Generate reports for operational activities. - Review billing reconciliation system and modifies charges when indicated. - Function as a liaison between the department and transcription and either add or deletes charges based on physician's dictation. - High school diploma and college courses in related field (computer science or health administration - or High school diploma 3+ years work-related experience. - Must have understanding of medical terminology required from previous work-related experience. - Working knowledge of software applications normally gained through computer experience without formal training, or attendance of formal training programs applicable to database management. - Must have analytical and database management ability sufficient to evaluate data needs, implement and maintain such systems and evaluate clinical, financial, and outcomes data. Licensure, Certifications, and Clearances: - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Utilization Management Supervisor Location: Altoona, PA, United States Job Description: Job ID: 7950407450 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Hybrid Facility: Home Nursing Agency Department: Utilization Mgmt Location: 20 Sheraton Drive, Altoona, PA Union Position: No Salary Range: $ 31.09-52.18 USD UPMC Utilization Management Supervisor (Hybrid) Responsible for the development and ongoing daily activities of the UM staff within the organization. Provides oversight of OASIS documentation accuracy to ensure positive clinical and reimbursement outcomes Monday-Friday 8:00 am-4:30 pm. This position is mostly remote. Candidate will need to live near UPMC facility for training and meeting new hires on site. Responsibilities: - Directs and provides education to all UM Professionals regarding the assessment of patients and the establishment of a plan of treatment at the start of care and reimbursement issues including complex reimbursement system and individual payor home care eligibility requirements. Serves as the OASIS resource/educator and oversees OASIS compliance and competencies. Educates, reviews and supervises ICD-10 code assignments, completion of 485?s/POC, OASIS assessment completion and corrections, and complies with end of month deadlines. - Focuses on customer service and continually strives to perform the duties of their job in a manner that will result in optimal patient satisfaction. Support staff to obtain and maintain ICD coding and OASIS certifications. Conduct a comprehensive review and analysis of the patient’s Plan of Treatment using standard tools and guidelines. Proven ability to facilitate change. - Responsible for the continuous performance monitoring appraisals for staff and is responsible for overseeing ongoing performance issues. Performs interviewing, hiring, payroll and other employee related activities. Compile and analysis productivity of UM professionals to ensure timely review and distribution of workload. Gathers and disseminates information to appropriate personnel in order to enhance OASIS accuracy and the achievement of positive clinical and financial outcomes. - Participates as a member of agency committees. Attends compliance training and adhere to the organization’s standards of conduct, policies and procedures. Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned. - Assists in the development, coordination and facilitation of the orientation plan for all employees and yearly education and mandatory competencies. Performs duties and job responsibilities in a fashion which coincides with the service management philosophy of the organization towards patients, visitors, staff, peers, physicians and other departments within the organization. Identifies, develops and participates in process improvement opportunities within the home health organization that will enhance the quality of services we provide. Qualifications: Must meet one of the following criteria: RN: Graduate of an accredited nursing program. Licensed as Registered Nurse by the Pennsylvania State Board of Nursing. PT: Graduate of a physical therapy education program approved by the Commission on Accreditation in Physical Therapy Education (CAPTE or APTA). Licensed through examination by the Pennsylvania State Board of Physical Therapy. OT: Graduate of an Occupational Therapy Program, which meets the requirements of the Accreditation Council for Occupation Therapy Education, (ACOTE) of the AOTA and be licensed through examination by the state Board of Occupational Therapy. SLP: Graduate at a Master’s level which meets education requirements for a Certificate of Clinical Compliance (CCC) in Speech Pathology or Audiology or meets the education requirements for certification and is in the process of accumulating the supervised experiences required by Certification. Baccalaureate degree Preferred (no change) Minimum 3 years home health experience RequiredICD coding certification Required within a year OASIS certification Required within a year Minimum 2 years management experience Preferred Demonstrated knowledge of Medicare, Medicaid and commercial insurance reimbursement as well as Conditions of Participation Required Minimum 2 years Utilization Management experience – Preferred Licensure, Certifications, and Clearances: Current licensure as a professional RN in the Commonwealth of PA? Required, or OT, or PT, or SLP Current CPR certification Required Current PA driver’s license Required Current auto insurance in state of residence Required - 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.