Purpose:

　　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 Sr. Professional Care Manager (RN) to help support the Hillman Cancer Centers mission of strong patient focused care.

　　The Sr. 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 Sr. Professional Care Manager will be 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 primarily with a Regular Full Time Daylight schedule Monday through Friday from 9:00 am to 6:00 pm. Residency in Greater Pittsburgh, PA area is preferred, as candidate will report to the UPMC Shadyside Cancer Pavilion (Pittsburgh/Shadyside, PA) for orientation and system training (approximately 4 weeks) and periodically as needed for in-person meetings (approximately one (1) day / month)

　　Interested in learning more about the Oncology nursing field and working with the best at the Hillman Cancer Center? Please check out our Oncology Nursing Blog (https://mycareer.upmc.com/impact-inspiration-oncology-nursing-at-upmc/) !

　　Responsibilities:

　　The Sr. 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.

　　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.

　　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.

　　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.

　　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.

　　Promotes patient safety. Supports CORE measures information for JCAHO requirements.

　　Evaluated issues, trends and recommends improvement to Care Manger Manager/Director and/or multi-disciplinary team.

　　Serves as a role model of excellent customer service and patient care.

　　Promotes advancement of knowledge and skills of other disciplinary teams and lay members of the community by serving as a resource to internal and external individual groups.

　　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.

　　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.

　　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.

　　Serves as a leader within the care management department in completing his/her assignment.

　　Graduate of approved school of nursing.

　　Two (2) years of nursing experience required.

　　BSN or related Bachelors degree required.

　　Two (2) year of care management experience or equivalent experience in the healthcare environment required.

　　Knowledge of healthcare financial and payor issues required.

　　Knowledge of state, local, and federal programs required.

　　Use of InterQual criteria preferred.

　　Oncology experience strongly preferred

　　Experience with telephonic triage preferred

　　Proficiency in utilizing technology, including comfort in accessing various software programs, strongly preferred

　　Licensure, Certifications, and Clearances:

　　Currently licensed as professional nurse in the Commonwealth of PA. UPMC Corporate Care Management Training Certificate of Completion required within 4-6 weeks of hire. UPMC approved Care Management certification preferred

　　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

　　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.

　　WiFi, network extenders, Powerline adapters, and other adapters are not allowed.