UPMC Corporate Revenue Cycle is hiring a Clinical Documentation Specialist to join our coding team. This position will be a work-from-home position working Monday through Friday during normal business hours. The Clinical Documentation Specialist (CDS) facilitates modifications to clinical documentation through concurrent interaction with physicians and other members of the healthcare team to ensure appropriate clinical severity is captured for the level of services rendered to all inpatients. If you are ready to take the next step in your coding career and have experience as a CDI Specialist, look no further! Responsibilities: - Participating at the organizational level in clinical documentation improvement initiatives - Communicate with physicians, face-to-face or via clinical documentation inquiry forms, regarding missing, unclear or conflicting medical record documentation to clarify the information, obtain needed documentation, present opportunities, and educate for appropriate identification of severity of illness - Preparing trended data for presentation one-on-one and small to medium groups of physicians - Demonstrate an understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix, secondary diagnosis, impact of procedures on the final DRG, and an ability to impart this knowledge to physicians and other members of the healthcare team - Be responsible for the day-to-day evaluation of documentation by the Medical Staff and healthcare team - Provide daily clinical evaluation of the medical record including physician and clinical documentation, lab results, diagnostic information and treatment plans - Three years of previous clinical acute care nursing experience medical/surgical experience to include critical care in conjunction with an expanded knowledge of DRG's; OR completion of Health Records Administration program (RHIA) or Accredited Record Technician (RHIT) AND 3 years of experience with the Prospective Payment System and DRG selection; OR specific knowledge as a consultant in Medical Record coding and DRG assignment required. - Prior CDI work experience preferred. - Knowledge of computer technology, quality assurance activities, DRG, Quality Insights/Utilization review background is highly preferred. - Ability to communicate with staff, physicians, healthcare providers, and other healthcare system personnel in a professional and diplomatic manner required. Licensure, Certifications, and Clearances: - Certified Coding Specialist (CCS) OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD) OR Doctor of Podiatric Medicine OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT) 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. *Employees practicing in Maryland: Respiratory Therapist license may be used in substitution of the aforementioned certifications and licensure. UPMC is an Equal Opportunity Employer/Disability/Veteran

Location: Remote PositionPay Range: $20.78 - $36.53 Position Summary: The Clinical Pharmacy Technician is an advanced pharmacy technician role that supports network-wide formulary management, therapeutic substitution processes, and clinical pharmacy operational initiatives across the AON network. This role partners closely with Regional Clinical Pharmacists to identify, coordinate, and execute opportunities that improve formulary adherence, optimize medication utilization, and support clinic transitions. The clinical pharmacy technician plays a critical role in quality assurance processes, therapeutic substitution execution, and the application of formulary adherence tools to drive alignment with AON preferred products. This position is responsible for facilitating timely and accurate implementation of clinical initiatives, monitoring utilization trends, and supporting data-driven decision-making. Working under the supervision of Regional Clinical Pharmacists, this role contributes to Pharmacy & Therapeutics (P&T) initiatives, drug shortage mitigation strategies, and other Network-Level clinical pharmacy efforts, serving as a key operational partner in advancing safe, effective, and cost-conscious patient care. Key Performance Areas: KPA 1 – Clinical Support · Assist with transcription verification processes to ensure accuracy and completeness of medication orders. · Support execution of therapeutic substitutions under pharmacist supervision. · Collaborate with Regional Clinical Pharmacists to ensure timely processing of substitution opportunities. · Maintain documentation and tracking of interventions. KPA 2 – Formulary Adherence & Optimization · Utilize formulary adherence dashboards to identify opportunities for AON preferred products. · Support review of non-preferred drug utilization. · Monitor trends and escalate gaps to clinical pharmacists. · Contribute to adherence improvement initiatives. KPA 3 – P&T and Clinical Initiatives Support · Assist with P&T initiatives to drive AON preferences. · Support implementation of formulary changes including biosimilars. · Participate in projects related to DUEs and cost optimization. · Assist with data collection and reporting. KPA 4 – Drug Shortage & Product Management Support · Assist with product conversions during drug shortages. · Support transitions to alternative agents per guidance. · Help communicate shortage updates and changes. KPA 5 – Supply Chain Operations & Issue Resolution · Work closely with Regional Clinical Pharmacists. · Communicate effectively with internal teams. · Support cross-functional collaboration. · Perform other duties as assigned. Position Qualifications/Requirements 1. Education: College degree (AS, AA or Higher) in Business/Health Care Administration or other related field, preferred. In lieu of degree, 4+ years of experience is required or the equivalent combination of education and experience. 2. Certifications/Licenses: · Certified Pharmacy Technician (CPhT), required. · Advanced Certified Pharmacy Technician (CPhT-Adv), required within 6 months. 3. Previous Experience: · Minimum of 5 years of experience as a pharmacy technician, 3 of which must be in hematology / oncology. · Experience working in OncoEMR or other EMRs, Preferred. 4. Core Capabilities: · Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment. · Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters. · Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback. · Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations. · Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required. · Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites. · Leadership and Mentoring: Effectively lead and facilitate group discussions, coach, mentor, motivate, and engage others to align to a common goal. Ability to effectively lead projects from inception through implementation and assessment. · Human Resources Management: Effectively hire, coach and support staff develop, as applicable, as well as manage resources, performance and employee relations, and supervise within established policies, procedures and legislation. · Computer Skills: - Proficiency in MS Office Word, Excel, Power Point, and Outlook required. 5. Travel: <25% 6. Standard Core Workdays/Hours (specify weekends and call requirements): Monday to Friday 8:00 AM – 5:00 PM.

Where You’ll Work Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. One Community. One Mission. One California Job Summary and Responsibilities As our Utilization Review LVN Precert I, your focus will be to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. The LVN assists in determining appropriateness, quality and medical necessity of referral requests using pre-established guidelines. This position supports the Medical Group in effective management of the managed care patient. This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review. To be successful in this role, you will effectively manage patient charts, demonstrating enthusiasm, efficiency, and empathy, while ensuring accurate application of criteria to support optimal patient care and operational flow. - Conducts pre-authorization referral reviews, following workflow as written, document criteria to make determination or recommendation and process the referral in a timely manner.- Manages assigned queues on a daily basis working oldest referrals first to assure 98% compliance with ICE timeframes.- Follows job work aide in sequence of performing job, including checking eligibility on health plan websites. Demonstrates 100% accuracy of identification of Medical Group member before referral review is initiated.- Determines correct type of referral and utilizes correct criteria in performing review and documents appropriate sections with 95% accuracy. Researches correct information and/or uses pend letter appropriately when facts are needed to reach determination.- Preps case thoroughly, concisely and clearly for physician review. Researches EMR, criteria, medical policy and past history of member to detail case cleanly for MD. Watches for follow up and processes denials as indicated, correct identification of reasons for denial.- Recommends and coordinates interventions to facilitate high quality, cost-effective care, monitoring treatment, progress and outcomes of patients. ***This position is work from home within California. Job Requirements Minimum Qualifications: - 0-3 years of LVN experience.- Graduation from an accredited Licensed Vocational Nursing program.- Clear and current CA Licensed Vocational Nurse (LVN) license.- Familiarity with healthcare regulations, including HIPAA, CMS, and state-specific requirements- Knowledge of UM operations.- Strong knowledge nursing requirements in a clinical setting.- Knowledge of utilization management programs as related to pre-set protocols and criteria.- Knowledge of health plans, medical specialty procedures and diagnoses.- Ability to work within an interdisciplinary structure and function independently in a fast paced environment while managing multiple priorities and meeting deadlines.- Ability to apply clinical judgment to complex medical situations and make quick decisions.- Ability to read and interpret benefit contract specifications.- Ability to understand and follow established criteria and protocols used in managed care functions.- Strong organization skills.- Effective telephone and computer data entry skills.- Ability to formulate ideas and solutions into appropriate questions and assess/interpret the verbal responses Preferred Qualifications: - Physician group experience preferred.- Experience at meeting deadlines by prioritizing workflow preferred.- - General knowledge of UM and Managed Care preferred.- Use of InterQual guidelines preferred.- Knowledge of California health plans and differences between commercial and advantage plans preferred.- Familiarity with business practices and protocols with ability to access data and information using automated systems preferred.- Ability to communicate effectively with coworkers, members, their families, physicians and health care providers preferred.

Where You’ll Work Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. One Community. One Mission. One California Job Summary and Responsibilities As our Utilization Review LVN, your focus will be to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary. The LVN assists in determining appropriateness, quality and medical necessity of referral requests using pre-established guidelines. This position supports the Medical Group in effective management of the managed care patient. This position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review. To be successful in this role, you will effectively manage patient charts, demonstrating enthusiasm, efficiency, and empathy, while ensuring accurate application of criteria to support optimal patient care and operational flow. - Manages assigned queues on a daily basis working oldest referrals first to assure 98% compliance with ICE timeframes.- Follows job work aide in sequence of performing job, including checking eligibility on health plan websites. Demonstrates 100% accuracy of identification of Medical Group member before referral review is initiated.- Determines correct type of referral and utilizes correct criteria in performing review and documents appropriate sections with 95% accuracy.- Researches correct information and/or uses pend letter appropriately when facts are needed to reach determination.- Preps case thoroughly, concisely and clearly for physician review. Researches EMR, criteria, medical policy and past history of member to detail case cleanly for MD. Watches for follow up and processes denials as indicated, demonstrating correct identification of reasons for denial.- Recommends and coordinates interventions to facilitate high quality, cost-effective care, monitoring treatment, progress and outcomes of patients. ***This position is work from home within California. Job Requirements Minimum Qualifications: - 3 years Utilization Management (UM) experience.- 5 years LVN experience.- Clear and current CA Licensed Vocational Nurse (LVN) license.- Strong knowledge nursing requirements in a clinical setting.- Knowledge of utilization management programs as related to pre-set protocols and criteria.- Knowledge of health plans, medical specialty procedures and diagnoses.- Ability to work within an interdisciplinary structure and function independently in a fast paced environment while managing multiple priorities and meeting deadlines.- Ability to apply clinical judgment to complex medical situations and make quick decisions.- Ability to read and interpret benefit contract specifications.- Ability to understand and follow established criteria and protocols used in managed care functions.- Strong organization skills.- Effective telephone and computer data entry skills.- Ability to formulate ideas and solutions into appropriate questions and assess/interpret the verbal responses. Preferred Qualifications: - Experience at meeting deadlines byprioritizing work flow preferred.- Physician group experience preferred.- General knowledge of UM and Managed Care preferred.- Use of InterQual guidelines preferred.- Knowledge of California health plans and differences between commercial and advantage plans preferred.- Familiarity with business practices and protocols with ability to access data and information using automated systems preferred.- Ability to communicate effectively with coworkers, members, their families, physicians and health care providers preferred.