UPMC Health System

Title: Mobile Professional Care Manager - Community Care Behavioral Health (Cambria/Somerset Counties) Location: Cambria/ Somerset Job ID: 7872073019 Status: Full-Time Remote Union Position: No Job Description: Salary Range: $ 29.29-48.21 USD UPMC Community Care Behavioral Health is seeking a full-time Mobile Professional Care Manager to support the Care Management Department in Cambria & Somerset Counties! The Mobile Professional Care Manager will work flexible hours, Monday through Friday, with travel throughout Cambria & Somerset Counties to meet with members within the community. This role is primarily community-based with the majority of time spent traveling in the community, with the remainder of the Care Manager's work completed remotely/from home! Responsibilities: - Conducts face-to-face member assessments by visiting the member in the member's community, place of residence, or facility. - Conduct on-site hospital coordination for discharge planning with facility staff if needed. - Coordinate with member's physicians to ensure follow-up and coordination of care - Collaborates with providers and others in order to obtain initial assessment, treatment planning and aftercare planning for members. - Conducts member assessments identifying behavioral, clinical, social, and environmental concerns and needs. - Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans. - Ensures that cases are managed and documentation is within established timeframes in accordance with departmental standards. - Participates in case conferences, interagency and provider treatment planning and departmental meetings. - Makes referrals and provides expertise regarding community and governmental agencies. - Assesses member's knowledge of their clinical condition and the need for further education - Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members. - Develops specific outreach plans for assigned members who do not maintain regular contact with their medical or behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care. - Receives and responds to complex and crisis calls. - Coordinates care and services across the continuum of care with case management, physicians, pharmacy, behavioral health, and other providers or health plan departments as appropriate. - Identifies barriers to care and develops specific integrated plan of care in collaboration with the member, family, provider, and UPMC Health Plan staff. - Maintains contact with and refers members to community-based case management services as appropriate. - Identifies provider issues and recommendations for improvement. - Demonstrates knowledge of clinical treatment, case management and community resources. Qualifications: - Pennsylvania Licensure in health or human services field and master's degree OR licensed RN (BSN preferred) OR Paramedic/EMT with 6-8 year of experience. - Preference will be given to candidates with a Pennsylvania Licensure in health or human services field and master's degree OR licensed RN - Three years of experience in behavioral, clinical, utilization management, home care, discharge planning, and/or case management required. - Prior experience in behavioral health or SUD highly preferred. - Five years of experience with community-based case management, and behavioral health experience preferred. - General knowledge of best practices in working with special needs populations in the public sector preferred. - Detail-oriented with excellent organization skills required. - High level of oral and written communication skills required. - Proficiency in Microsoft Office products is preferred and ability to learn new software applications required. - Three years experience in a managed care environment preferred. - Experience with geriatric population preferred. Certification in substance use disorders helpful. Licensure, Certifications, and Clearances: - CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire - Automotive Insurance - Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) - Clinical Social Worker (CSW) OR Emergency Medical Technician (EMT) OR Licensed Clinical Social Worker (LCSW) OR Licensed Marriage & Family Therapist OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR Paramedic OR Psychologist OR Registered Nurse (RN) - Driver's License - Act 33 with renewal - Act 34 with renewal - Act 73 FBI Clearance with renewal - *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

Title: Telephonic Care Manager (RN) - Medicaid Case Management Location: Pittsburgh United States Job ID: 7862359787 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Hybrid Department: 80751 ZCMS1 Administration Job Description: Union Position: No Salary Range: $ 32.59-52.18 USD Are you an experienced nurse with an interest in care management? Do you have a passion for the long-term care management of patients with chronic conditions? Is project management something you're experienced with and enjoy doing? We are you looking for you! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support our Community Medicine Inc. team and PCMH Learning Network initiatives, primarily serving UPMC for You Medicaid members. This telephonic role is primarily remote, with standard daylight hours (Monday-Friday) and occasional travel within Pennsylvania. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic 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 to close 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 other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by telephone or other electronic communication methods. Title and salary will be determined based upon education and nursing experience for Sr. Professional Care Manager within the Insurance Services Division. Responsibilities: - Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. - Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. - Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate. - Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. - Refer members to appropriate health plan programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. - Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. - Document all activities in the Health Plan's care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. - Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns. Qualifications: - Minimum of 2 years of experience in a clinical setting and case management nursing required. - BSN preferred. - Project Management experience is a bonus! - Ability to interact with physicians and other health care professionals in a professional manner required. - Excellent verbal and written communication and interpersonal skills required. - Computer proficiency required. - Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement. - Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Licensure, Certifications, and Clearances: - Case management certification or approved clinical certification preferred - 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

Coordinate comprehensive discharge plans by assessing patients' needs, facilitating communication among care teams, and ensuring timely arrangements for post-hospital care to achieve optimal patient outcomes and enhance care transitions.

Title: Specialty Cytogenetic Technologist Location: Pittsburgh United States Job ID: 7709062264 Status: Casual Regular/Temporary: Limited Shift: Day Job Work Arrangement: Remote Facility: Magee-Womens Hospital of UPMC Department: Special Genetics_PCL Union Position: No Salary Range: $ 31.56-43.85 USD Job Description: Magee-Womens Hospital of UPMC is hiring a casual (per diem) Specialty Cytogenetic Tech to support the UPMC Cytogenetic Laboratory (UCL)! This role will allow for a flexible work schedule as well as the opportunity to work remotely! The UCL is a state-of-the-art facility where you will have the opportunity to make an impact on life-changing medicine. Using both traditional cytogenetic techniques as well as molecular cytogenetics by fluorescence in situ hybridization (FISH) and genome-wide array comparative genomic hybridization (aCGH), the UCL performs chromosome studies on a wide variety of specimens, giving our patients the best opportunity to get the answers they need. Responsibilities: - Image captures appropriate number of cells on each case on the Department's computerized imaging system. - Prepares karyograms for each case on the imaging system and analyzes them for the presence of chromosomal defects. - Cleans and maintains supplies and equipment. Monitors temperature and carbon dioxide levels in incubators to ensure growth of cultures. - Assists with the teaching and training of students and various hospital professionals. - Prepares slides from harvested cells. Performs appropriate banding and staining procedures to ensure optimal visibility of chromosome structure. - Performs various additional testing being able to determine when specialized techniques are necessary based on initial chromosome analysis. - Participates in a rotating weekend and holiday on-call schedule and carries a pager. Performs techniques necessary to acquire preliminary cytogenetic diagnosis on STAT newborns. Calls physician or nurse practitioner with preliminary results. Retrieves and sets up specimens as required. - Performs specimen harvesting, slide making, and/or banding as needed when on-call. - Analyzes metaphase chromosomes on the microscope or using image analysis system. Counts the number of chromosomes and analyzes the structure of each chromosome to determine if a genetic defect is present. - Assists Lead Technologists with QA/QI monitoring and data collection. - Retrieves samples to process for analysis. Initiates cultures using sterile techniques following procedures to ensure optimal growth of samples. Determines number of cultures to be set up based on size of sample and clinical diagnosis. - Performs subcultures when necessary and determines number of subcultures to be initiated from original cultures based on amount of cell growth present. Monitors growth of subcultures and determines when cultures are ready for harvest. Harvests primary and subcultures when ready. Adjusts harvesting procedures daily based on environmental conditions and appearance of other recent harvests. - Responsible for following the mandatory reporting procedures for any incident or serious event that did affect or potentially could have affected the clinical care of any patient. - Changes media in cultures according to established schedules. Chooses correct culture media and places in appropriate incubator. - Participates in the organization and direction of ancillary work performed by support and service personnel and volunteers. - Maintains records of culture initiation, growth, manipulation, and harvests on all specimens. - Monitors growth of specimens and determines when primary cultures should be harvested. Determines when subcultures should be performed on non-primary cultures. Qualifications: - Bachelor degree in Medical Technology, Biology or Chemistry. - Minimum of three years clinical cytogenetics lab experience to (a) acquire a professional level of knowledge in cytogenetics, (b) acquire expertise in the operation of equipment and the performance of clinical diagnostic testing procedures. - Must be certified as a Technologist in Cytogenetics by examination through the Board of Certification of the American Society for Clinical Pathologists [CG(ASCP)]. - Must maintain certification through continuing education credits. - Successful demonstration of the completion of the competencies required by the department/unit. Licensure, Certifications, and Clearances: - CG(ASCP) certification required and must maintain certification. - American Society for Clinical Pathology - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Title: Telephonic Care Manager (CHC)- Complex Care Unit Location: Pittsburgh United States Job ID: 7823759660 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: UPMC Health Plan Department: CHC Service Coordination Union Position: No Salary Range: $ 34.49-56.83 USD Job Description: UPMC Health Plan has an exciting opportunity for a Telephonic Care Manager position in the Community Healthchoices department. This is a full time position working Monday through Friday 8:00 a.m. to 5:00 p.m. with flexibility. This is a remote position, but due to offices located in Pennsylvania for onsite needs of technology or operational reasons candidates are expected to reside in Pennsylvania. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Responsibilities: - Warm transfers member for IEB referrals as appropriate. - Successful manipulation of Excel Spreadsheets and accurate Excel spreadsheet data management is required. - Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. - Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. - Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. - Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. - Refer members to appropriate health plan programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. - Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. Document all activities in the Health Plan's care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. - Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns. Prefer experienced: - positive, teachable Telephonic Care Manager to maintain NFI caseload while primary focus is Complex Care Unit and challenging, successful discharges. - Managing complex cases, such as Forensic, EPSDT, LIFE, and MCO transfer cases in addition to Participants with complex circumstances such as traumatic brain injury, ventilator dependence, or other diagnoses. - Responsible for timely management of NFI caseload activities such as tasking, referrals, and collaboration with other stakeholders. - Ability to work as a team member and HCBS liaison in addition to listening and carrying out instructions via Supervisor directives and Workflows/Job Aids independently. - Provide expedited care coordination through initial outreach, assessment, and stabilization of CHC benefits. - CCU's focus is to stabilize incoming CHC Participants until a primary HCBS SC is assigned. - As needed, CCU may also assist HCBS SC's by providing additional support for certain established Participants such as with Nursing Facility discharges, Nursing Home Transitions, or other complex facility discharges. - Should be an RN. Need to be a registered nurse. Qualifications: - Minimum of 2 years of experience in a clinical setting and case management nursing required. - BSN preferred. - Ability to interact with physicians and other health care professionals in a professional manner required. - Excellent verbal and written communication and interpersonal skills required. - Computer proficiency required. - Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. - Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. - Most cable and fiber optic providers can meet the requirement. - Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Licensure, Certifications, and Clearances: Case management certification or approved clinical certification preferred - 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

Title: Telephonic Care Manager (RN) - Medicare Case Management Location: Pittsburgh United States Job ID: 7835987939 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: UPMC Health Plan Department: Medicare Clinical CM Union Position: No Salary Range: $ 34.49-56.83 USD Job Description: Purpose: Are you an experienced nurse looking for the next challenge in your career? Do you have knowledge of care management or care coordination? The UPMC Health Plan is hiring a full-time Telephonic Care Manager to support our Medicare Case Management team. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic 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 to close 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 other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by telephone or other electronic communication methods. This position is primarily remote; however, occasional travel to Downtown Pittsburgh will be required. This position will work standard daylight hours, Monday through Friday with occasional evenings required. Responsibilities: - Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. - Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. - Review member’s current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate. - Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. - Refer members to appropriate health plan programs based on assessment data. Engage members in education or self management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. - Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. - Document all activities in the Health Plan’s care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. - Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns. Qualifications: - Minimum of 2 years of experience in a clinical setting and case management nursing required. - BSN preferred. - Ability to interact with physicians and other health care professionals in a professional manner required. - Excellent verbal and written communication and interpersonal skills required. - Computer proficiency required. - Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement. - Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Licensure, Certifications, and Clearances: - Case management certification or approved clinical certification preferred - Registered Nurse (RN) 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

Title: Health Care Manager (Pediatric) Location: Pittsburgh United States Job Description: Job ID: 7823742628 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: UPMC Health Plan Department: Medical Mgmt Medicaid Union Position: No Salary Range: $ 27.89-48.21 USD UPMC Health Plan is hiring a full-time Pediatric Health Care Manager to support the Medical Management Medicaid team. This position will predominantly work from home and primarily work standard daylight hours, Monday through Friday with intermittent evening hours as needed. The team is based out of downtown Pittsburgh, but team members may reside anywhere in Pennsylvania. Occasional local travel may be required in the future. The Health Manager ensures continuity and coordination of care for Health Plan members with chronic conditions and complex health needs. Responsibilities: - Provides members, providers, and other stakeholders with information concerning benefits and coverage, and provides accurate information to members and families. - Monitors and evaluates effectiveness and outcome of treatment plans, restructures as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care and maximal use of community supports and resources. - Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented. - Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues. - Preserve confidentiality of the member. - Develop and coordinate an individualized treatment plan with the member, member’s family, and providers. - Evaluate the effectiveness of the treatment plan and identify gaps in service. Make recommendations for changes when indicated. - Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and network providers. - 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. - Follow-up with the member according to established timeframes to monitor their care to assess whether quality care is being provided in an appropriate setting. - 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. - Identifies provider issues and recommendations for improvement. - Contact potential case management members to determine if there is a need for case management intervention. - Receives and responds to complex calls regarding requests for services or resolution of complex issues. - Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services. - Performs clinical reviews, service authorization and care coordination (or oversight and supervision) for all Health Plan members receiving services. - Complete Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and Security Awareness. - Provide reports on case management cases or activities as requested. - Perform in accordance with system-wide competencies/behaviors. - Appropriate documentation in the care management documentation system including assessments, problems, goals and interventions. - Assumes responsibility for health plan member’s access to in-plan and/or supplemental services as medically indicated - Interfaces with and refers members to community-based resources and other supportive services as appropriate. - 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. - 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. - Conduct comprehensive assessment of needs and coordination of care activities for individuals with primary diagnosis of alcohol or substance use addiction Qualifications: - Master’s degree in human service field plus licensure required or Licensed Pennsylvania RN with 6-8 years clinical experience required - Preference will be given to those with licensure in a human services field (LSW, LCSW or LPC) - Five years of experience in clinical, care coordination, and/or case management required. - Pediatric experience highly preferred. - Three years of experience in a managed care environment preferred. - General knowledge of best practices in health care, emphasizing work with special needs populations and in provider systems. - Ability to interact with physicians and other health care professionals in a professional manner required. - Computer proficiency required. - Experience with Microsoft office products preferred. - Excellent verbal and written communication and interpersonal skills required. - Knowledge of community resources required. Licensure, Certifications, and Clearances: - Registered Nurse (RN) or Social Services Licensure (LSW, LCSW, LPC) - Licensure in other states as assigned - Case management certification or approved clinical certification preferred UPMC is an Equal Opportunity Employer/Disability/Veteran

Title: Community-Based Social Worker (Cambria/Somerset Counties) - LSW, CSW, LPC Location: Remote United States Job ID: 2600009J Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Traveling Facility: UPMC Health Plan Department: Pop Health Case Mngt Location: Work From Home, US Union Position: No Salary Range: $ 29.29-48.21 USD Job Description: At UPMC Health Plan, every team member helps deliver Life Changing Medicine. We are hiring a full-time Mobile Professional Care Manager to join our Population Health team. In this role, you'll work collaboratively with our Population Health Team to support members directly in their communities -helping them navigate challenges, access resources, and improve their overall well being. What You'll Do - Provide in‑person and community‑based care management to UPMC Health Plan members across Cambria and Somerset counties (with occasional nearby travel). - Complete holistic assessments focusing on behavioral health, physical health, social needs, and environmental factors. - Coordinate member care across physicians, behavioral health providers, community agencies, and internal UPMC teams. - Follow members in their homes, residences, and facilities to ensure they receive the support they need. - Participate in occasional training and meetings in Pittsburgh. Schedule - Full-time, Monday-Friday - Daylight hours: 8:00 AM - 4:30 PM - Community based for in-home visits. - Includes some remote work - which is a perk of this position! Who We're Looking For - Licensed Social Workers (LSW/LCSW) or Licensed Professional Counselors (LPC). - Passion for helping individuals overcome barriers and supporting whole‑person health. Why Join UPMC? - Be part of a mission-driven organization making a tangible difference every day. - Work independently while still having strong support from a collaborative team. - Help shape the future of care management and community-based health. Responsibilities: - Conducts face-to-face member assessments by visiting the member in the member's community, place of residence, or facility. Conduct on-site hospital coordination for discharge planning with facility staff if needed. Coordinate with member's physicians to ensure follow-up and coordination of care - Collaborates with providers and others in order to obtain initial assessment, treatment planning and aftercare planning for members. - Conducts member assessments identifying behavioral, clinical, social, and environmental concerns and needs. - Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans. - Ensures that cases are managed and documentation is within established timeframes in accordance with departmental standards. Participates in case conferences, interagency and provider treatment planning and departmental meetings. - Makes referrals and provides expertise regarding community and governmental agencies. - Assesses member's knowledge of their clinical condition and the need for further education - Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members. - Develops specific outreach plans for assigned members who do not maintain regular contact with their medical or behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care. - Receives and responds to complex and crisis calls. - Coordinates care and services across the continuum of care with case management, physicians, pharmacy, behavioral health, and other providers or health plan departments as appropriate. - Identifies barriers to care and develops specific integrated plan of care in collaboration with the member, family, provider, and UPMC Health Plan staff. - Maintains contact with and refers members to community-based case management services as appropriate. Identifies provider issues and recommendations for improvement. Demonstrates knowledge of clinical treatment, case management and community resources. Qualifications: - Pennsylvania Licensure in health or human services field and master's degree OR licensed RN. OR Paramedic/EMT with 6-8 year of experience. Preference will be given to LSW, LPC or CSW. - Three years of experience in behavioral, clinical, utilization management, home care, discharge planning, and/or case management required. - Detail-oriented with excellent organization skills required. High level of oral and written communication skills required. - Proficiency in Microsoft Office products is preferred and ability to learn new software applications required. Licensure, Certifications, and Clearances: - Clinical Social Worker (CSW) OR Emergency Medical Technician (EMT) OR Licensed Clinical Social Worker (LCSW) OR Licensed Marriage & Family Therapist OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR Paramedic OR Psychologist OR Registered Nurse (RN). Preference will be given to LSW, CSW or LPC. - Act 33 Child Clearance w Renewal - Act 34 Crim Clearance w Renewal - Act 73 FBI Clearance - Driver's License - CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire - Automotive Insurance - Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) - - 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

Title: Research & Institutional Billing Coordinator Location: Pittsburgh United States Job Description: Purpose: Do you have experience with reimbursements? Do you have research and institutional billing experience? UPMC is hiring a full-time Research and Institutional Billing Coordinator. This position would work Monday through Friday during daylight hours and is eligible to work remotely, with occasional on-site work at the Quantum One Building as needed for the first few months. The Research and Institutional Billing Coordinator facilitates the appropriate billing and prompt/correct reimbursement for all monies owed by third parties. They monitor the auditing of research requisitions to ensure proper billing of research related services, coordinate the billing process within the Health Services Division, and identify inefficiencies. Additionally, the Coordinator monitors the institutional accounts to ensure appropriate registration and reimbursement validation, and they monitor high dollar/aged accounts receivable to ensure collectability. If you have research and institutional experience and are ready to grow your career, apply today! Responsibilities: - Review monthly institutional statements for accuracy, and make any necessary charge transfers r adjustments as well as contact to distribute bulk payments on institutional accounts to the specific charge transactions. - Responsible for Bad Debt process/Agency placements. - Prepare/process facility intercompany journal entries. - Support and contribute to UPMC core values and guiding principles and abide by all UPMC departmental policies, procedures and goals in the process of performing job responsibilities. - Incorporate acts of dignity and respect in daily interactions. - Obtain research requisitions and document accordingly. - Perform account analysis on problematic/aged accounts. - Provide recommendations to develop process improvements relative to research and institutional billing/collections. - Monitor accounts receivable to facilitate the prompt resolution of accounts or issues with involved parties including the Revenue Cycle, Hospital Departments and outside entities. - Follow up status calls to institutional contact for payment. - Assist in establishing goals to reduce the AR, improve cash collections and accounts receivable aging. - Perform all duties and responsibilities according to the philosophy and standards of UPMC, embracing the system-wide core competencies. Adhere to the UPMC and Revenue Cycle Standards of Conduct. - Refrain from disclosing or revealing confidential information to any person and do not access patient or coworker records (either electronic or files) except as specifically necessary to perform job duties. - Document appropriate account activity and comment codes in respective billing system. - Collate monthly invoice statements, retrieve and file folders as well as submission of monthly statements via e-mail or US mail for reimbursement. - Support Revenue Cycle areas to ensure compliance of all revenue cycle protocols. - Function as a liaison between research coordinators, research principal investigators, Compliance and the Revenue Cycle. - Register Institutional/Research professional and facility accounts in the Billing System. - Upon request, provide all applicable rates for clinical trials and other requests. Qualifications: - High School graduate or equivalent and 2-4 years of health insurance operations, claims processing or general auditing experience required. - 2-4 years data entry experience. - Keyboard dexterity and accuracy. - Knowledge of medical terminology, ICD-9 and CPT coding. - Knowledge of HMO, POS, PPO, Medicare, SNP, CHIP and Medicaid plans. - Detail oriented with excellent organizational, interpersonal and communication skills. - Knowledge of MS Office products. Licensure, Certifications, and Clearances: - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Perform authorization activities for various patient services, ensuring accurate coding and compliance with quality standards. Collaborate with internal and external contacts to enhance customer satisfaction and timely service delivery.