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The Care Manager Associate (CMA) position will be part of the UPMC Health Plan’s Community Services Community Paramedic Team. The team expands paramedic roles from emergency care to a focus on non-emergent and preventative health services tailored to individuals’ needs and goals. The CMA will begin their journey in mobile care management while helping resolve members’ SDOH issues, develop a community resource knowledge-based understanding while collaborating with multidisciplinary resources and providers, and manage referrals using administrative skills for the Health Plan’s one of a kind's homebound vaccination program. All this significantly positively impacts members’ health and well-being.

The CMA works business hours in a hybrid work structure, with minimum weekend, after hours, or holiday coverage as needed by the department. This is a flexible community-based position that requires travel to hospitals, provider sites, and member residences within Allegheny County. After the successful completion of orientation and training, this role works remotely when not out in the community!

In collaboration with the Community Paramedic team the CMA coordinates the appropriate support services and resources throughout the Community Services Team at UPMC Health Plan to facilitate effective care plans that achieve optimal satisfaction, and clinical, and financial outcomes along the defined continuum of care.

Through the CMA’s collaborations, practical comprehension and hands-on experience in clinical care/utilization management will result by collecting and assisting with face-to-face documentation for complex care management assignments. This opportunity will also build on communication and administrative skills during vaccination season by supporting the homebound vaccination processes.

The Health Plan Community Services Team is a multidisciplinary team providing mobile face-to-face interactions in the community to address any physical or behavioral health conditions and/or social determinants of health needs that might be negatively impacting the health and well-being of their members. The Community Services team is composed of several smaller specialized teams that provide intense case management and mobile interventions to best serve the communities in which they live and work.

Strategic Consulting Partners (SCP) is an award-winning, woman-owned, minority, small business. As a member of the SCP organization you will work as a contractor for UPMC to improve the health and well-being of the UPMC Health Plan members in our communities.

Benefits Available through SCP include:

+ Medical insurance

+ Vision insurance

+ Dental insurance

+ Disability insurance

+ 401(k)

+ Paid Time Away from Work: 11 Paid Holidays and 2 weeks PTO your first year

Responsibilities

+ Review Health Plan data for services the member has received and identify gaps in care based on clinical standards of care.

+ Assist clinical team with scheduling transportation, scheduling appointments, and tracking utilization.

+ Refer members to appropriate case management, health management, or lifestyle programs based on assessment data.

+ Assist members with non-medical needs that affect health and access to care.

+ Successfully engage member in developing an individualized plan of care in collaboration with the member’s care team.

+ Document all activities in the Health Plan’s care management tracking system following Health Plan standards based on information obtained from interaction with members and providers.

+ Recognize and demonstrate shared accountability in development of a care plan with the member/caregiver as well as the team members to ensure optimal outcomes.

+ Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient’s health, wellbeing, safety and rights.

+ Maintain an understanding of all health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and health management policies and procedures.

+ Interfaces with and refers members to community-based resources and other supportive services as appropriate.

+ Performs in accordance with system-wide competencies/behaviors.

+ Performs other duties as assigned.

+ Bachelor’s degree in social work or associate degree in another health or human services field that promotes the physical, and psychosocial well-being of those being served. No license is required.

+ Managed care experience preferred.

+ Ability to interact with other health care professionals in a professional manner required.

+ Computer efficiency is preferred. Excellent verbal and written communication and interpersonal skills are required. Knowledge of community resources is preferred.

+ Value for and ability to deliver excellent customer service.

Licensure, Certifications, and Clearances:

+ Act 34

+ CPR Certification preferred

UPMC is an Equal Opportunity Employer/Disability/Veteran