Clinical Care Manager (RN) - Perinatal Addiction Services

Job Description

Purpose:
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If you’re a nurse who believes where and how care is delivered can change lives—especially for mothers most at risk—this role was built for you! UPMC Health Plan is hiring a full-time Clinical Care Manger to support the Maternity team's Women-Centered Recovery Model of Care. The Women-Centered Recovery focuses on providing perinatal recovery support to UPMC Health Plan members with substance use disorders.

The Clinical Care Manager role nurse will deliver face-to-face, community-based care management for pregnant and postpartum members (up to 1 year postpartum), with a strong emphasis on perinatal addiction services, Medication for Opioid Use Disorder (MOUD), and harm reduction. The role blends mobile field work, occasional virtual visits, and care coordination, supporting members in provider offices and in their homes. The team is based in downtown Pittsburgh; however, this team member will be in a mobile position and work standard daylight hours. Monday through Friday. Mileage is reimbursed.

Responsibilities:

• Assist members with transition of care between health care facilities including sharing of clinical information and the plan of care.
• Document all activities in the Health Plan's care management tracking system following Health
• 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.
• Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
• Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.
• Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.
• Engage members in the Beating the Blues or other education or self-management programs.
• Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
• Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
• Present or contribute to complex case reviews 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.
• Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.

• Minimum of 2 years of experience in a clinical setting and case management nursing required
• BSN preferred
• Maternity Experience Required
  • Experience working in addiction services, specifically related to maternal addiction, medications for opioid use disorders, and harm reduction approaches preferred
• CARN – Certified Addiction Registered Nurse (strongly preferred)
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
• Excellent organizational skills
• High level of oral and written communication skills
• Computer proficiency required
• Minimum 1 year of health insurance experience required
  
  Licensure, Certifications, and Clearances:
• Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role)
• 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)
• Certified Case Manager (CCM)
• Driver's License
• Registered Nurse (RN)
• 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