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The Manager is responsible for supervising the daily operations of the Care Management department, reporting directly to the Director. Key areas of accountability include training, auditing, systems support (including Care Management Technology and InterQual), management of concurrent denials, and reporting functions. The Manager leads initiatives to design, implement, assess, and refine Care Management practice standards. They collaborate closely with Care Management staff to ensure patients transition safely, effectively, and efficiently throughout the continuum of care. This position will lead and direct RN staff to safely and efficiently move patients across the continuum of care with a team that is self-sufficient and collaborative in a fast-paced inpatient hospital environment.

Responsibilities:

+ Manages daily operations of Care Management staff and supports departmental goals under the Director’s guidance.

+ Develops reporting tools and analyzes data to evaluate care management effectiveness, denial trends, and length of stay variation.

+ Collaborates across departments to address care coordination issues and drive performance improvement.

+ Oversees staff training, documentation standards, audits, and performance reviews.

+ Supports budget management, ensures accurate reporting, and facilitates safe, efficient patient care transitions.

+ Serves as a resource for care and denial management processes and participates in leadership development.

+ MSN/MS in related field OR enrolled within 1 year of hire & complete within 3 years of enrollment

+ 3 Years of experience required; 3 years of experience in Care Management, 1 year of leadership experience.

+ Hospital leadership experience preferred

+ Proficiency in Microsoft products preferred. **Licensure, Certifications, and Clearances:**

+ Current licensure as a Registered Nurse in practicing state required.

+ UPMC approved Care Management certification or agreement to obtain upon hire required.

+ Act 33 / Act 34 / Act 73 with renewal

+ Requires strong clinical expertise, leadership, and critical thinking to coordinate patient care and optimize resource use.

+ Must have working knowledge of medical treatment standards, regulatory requirements, and managed care principles.

+ Proven ability to analyze data, recommend solutions, and implement actions.

+ Excellent communication, negotiation, and conflict resolution skills essential.

+ Must be self-motivated, committed, and capable of driving practice improvements across the care continuum.

+ Ability to foster collaboration, lead change, and apply innovative strategies to enhance team performance and patient outcomes is expected.

*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