Professional Care Manager (RN) - (Medical Oncology)

Professional Care Manager (RN)

UPMC Hillman Cancer Center is internationally recognized for its leadership in the prevention, detection, diagnosis, and treatment of cancer and is the region's only comprehensive cancer center designated by the National Cancer Institute.

As the preeminent institution in western Pennsylvania for the delivery of cancer care, the performance of basic, translational, and clinical research, and the education of the next generation of cancer researchers and physicians, UPMC Hillman Cancer Center is exceptionally well-positioned to contribute to the global effort to reduce the burden of cancer.

UPMC Hillman Cancer Center is currently hiring for a regular full-time Professional Care Manager (RN) to help support the Hillman Cancer Centers mission of strong patient focused care. The Professional Care Manager, UPMC Hillman is a newly created position that will provide expert navigation and concierge-level support to patients who are seeking oncology care within the UPMC Hillman Cancer Center umbrella of services.

The Professional Care Manager will provide symptom management and telephonic triage for existing patients while also being the entry point for patients, connecting directly with UPMC HCC provider offices, to facilitate new appointments and transitions in care across the entire UPMC HCC network. This position offers a $6,000 sign-on bonus and will work from home with a regular full-time daylight schedule Monday through Friday.

Responsibilities:

• The Professional Care Manager, UPMC Hillman Cancer Center will provide telephonic concierge support to prospective patients in connecting to the right provider as they navigate their cancer care journey while also providing symptom management and telephonic triage for existing patients.
• Reviews medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
• Collaborates with patients, caregivers, internal/external healthcare providers, agencies and payers to plan and execute a safe discharge. Re-evaluates and revises discharge plan as patient clinical condition merits. Develops alternative/multiple discharge plans in anticipation of patient need for post-acute services. Uses InterQual criteria to justify appropriate LOC (Skilled, Rehab, Home Care, DME, etc.) and obtain all necessary payer authorizations for post-acute care. Documents Freedom of Choice re: post-acute services.
• Serves as resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute services coverage and availability.
• Attends Department meetings and Corporate Care Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM policies and procedures, community resources. Ensures compliance with all payer and government regulations.
• Promotes patient safety. Supports CORE measures information for JCAHO requirements.
• Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor, Attending Physicians and clinical team to obtain necessary information and documentation to support LOC. Initiates acceptance of lower LOC when appropriate with assistance from billing office. Obtains Consent to Appeal on Behalf of Member on all cases with concurrent denial.
• Starts discharge planning on admission and ensures DC documentation is completed and updated regularly. Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge. Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge. Documents all Avoidable Days in CANOPY system.
• Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care (Inpatient, OBS, etc.) Obtains all necessary authorizations for level of care including admission and continued stay. Follows payer-specific requirements to obtain and document authorizations.

• Graduate of approved school of nursing.
• Two (2) years of nursing experience required.
• BSN or related bachelor's degree required.
• Previous case management experience preferred.
• Knowledge of healthcare financial and payor issues preferred.
• Knowledge of state, local, and federal programs preferred.
• Use of InterQual criteria preferred.
• Outpatient Medical Oncology experience strongly preferred.
• Experience with telephonic triage preferred.
• Proficiency in utilizing technology, including comfort in accessing various software programs, strongly preferred

Candidate must be able to support the Minimum Internet Service Requirements:

• Minimum Internet Service Requirements
• There are minimum speed and latency requirements:
• 20 MB download or greater
• 10 MB upload or greater
• Less than 50ms ping, and under 10ms jitter

• The following types of internet service are not allowed:
• Satellite
• Hotspot/cell phone
• DSL
• The equipment must also be connected directly to the internet modem/router with an ethernet cable.
• Wi-Fi, network extenders, Powerline adapters, and other adapters are not allowed.

Current licensure as a Registered Professional Nurse either in the state where the facility is located or in a state covered by a licensure compact agreement with the state where the facility is located. Employees practicing in Pennsylvania: UPMC Corporate Care Management Training Certificate of Completion required with 4-6 weeks of hire. UPMC approved Care Management certification preferred.

UPMC is an Equal Opportunity Employer/Disability/Veteran