Practice Based Care Manager, OP - Physician Network Admin at UPMC

Erie, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Dec, 25

Salary

0.0

Posted On

23 Sep, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Nursing, Patient Care, Case Management, Communication, Collaboration, Assessment, Care Coordination, Health Disparity Awareness, Interpersonal Skills, Flexibility, Documentation, Team Participation, Problem Solving, Cultural Competence, Patient Engagement, Health Insurance Knowledge

Industry

Hospitals and Health Care

Description

UPMC's Physician Network Admin is seeking a compassionate and driven Practice Based Care Manager to join a collaborative and creative team that’s reshaping how healthcare services are delivered. This physician office-based role focuses on coordinating care and developing personalized plans for patients with complex medical, behavioral, and social needs. You’ll work closely with patients, families, providers, and community resources to reduce barriers and improve outcomes. This is a unique opportunity to be part of a forward-thinking care model that prioritizes continuity, connection, and innovation. If you're passionate about making a meaningful impact in patient care, we invite you to apply! This full-time position will work day-shift, Monday through Friday. This position will be primarily based at one location but may require occasional travel to other practices. Once trained, the successful candidate may have the opportunity to perform their job responsibilities from home or in a hybrid model. *Please note that this position will require you to be based locally to Erie and is not a fully remote role. Responsibilities: Once patient is ready to leave the program, facilitates transition back to the Primary Care Doctor of the patients. Meets face to face with patients and family members initially and as needed to build a relationship, assess the patient's medical, behavioral health and social needs, identify barriers Works very closely with and maintains open communications with the Primary Care Physician of the extensive care program for direction and collaboration related to patient needs and assessment. Documents all assessments, interventions and plans of care completely and accurately into the electronic health record. Assess patient's appropriateness for enrollment into the Chronic Care Management program in terms of meeting criteria, approval by PCP, and patient and families willingness to participate. In collaboration with the team, develops and coordinates an individualized plan of care with the patient, patient's family, health insurance plan, providers and community agencies as applicable. Involves additional providers as needed to support the individualized plan of care based on identified needs of the patient and family and/or care giver. Plan designed to promote health, close gaps in care, decrease unplanned care. Actively participates in planned team meetings to monitor patient's status, evaluate the effectiveness of the individualized plan of care, and identify new needs and strategize for next steps. Maintains availability to patient and /or care giver as needed by phone or visit. Rotates call by phone according to systems developed in the practice for Chronic Care Management program. Follows up with patient and/or care givers regularly to assess patient's medical status or compliance to plan or or to offer assistance as needed. Graduate of approved school of nursing. Two (2) years of nursing experience in an outpatient setting required BSN or related Bachelor's degree preferred. Experience in a physician practice and/or home health care highly desired. Previous case management experience preferred. Ability to interact with physicians and other health care professionals in a professional manner required. Must have an understanding of health care disparity issues and have the ability to interact with members from diverse backgrounds in a culturally appropriate manner. Excellent verbal and written communication and interpersonal skills required. Ability to use independent judgment and compassion when carrying out tasks. Must be flexible with work schedule and may have to travel between offices as needed to see patients and or huddle with office staff. Must have flexibility to work within the hours established by the practice and to adapt to a changing environment while still functioning effectively as part of a multidisciplinary team. Licensure, Certifications, and Clearances: 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

Responsibilities

The Practice Based Care Manager coordinates care and develops personalized plans for patients with complex needs. They work closely with patients, families, and providers to improve health outcomes and facilitate transitions back to primary care.