Care Management Clinician - Behavioral Health (Monday-Friday)

PacificSource Health Plans•Boise, ID

1d•Hybrid

About The Position

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Clinicians incorporate the essential functions of professional case management concepts to enhance patients’ quality of life and maximize health plan benefits. These functions include but are not limited to: coordination and delivery of healthcare services, consideration of physical, psychological, and cultural factors, assessment of the patient’s specific health plan benefits, and additional medical, community, or financial resources available. Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.

Requirements

Minimum of three (3) years of clinical experience, including case management.
Clinical Social Worker, Licensed Professional Counselor, or Licensed Independent Clinical Social Worker with unrestricted license required in current state of residence.
OR Registered Nurse with current appropriate unrestricted state license based on line of business: Commercial and Medicare: Oregon, Idaho or Montana, and Washington; Medicaid and DSNP: Oregon.
Knowledge of health insurance and state mandated benefits.
Experience and expertise in case management practice including advocacy, assessment, planning, communication, education, resource management and service facilitation.
Ability to deal effectively with people who have various health issues and concerns.
Knowledge and understanding of contractual benefits and options available outside contractual benefits.
Knowledge of community services, providers, vendors and facilities available to assist members.
Ability to use computerized systems for data recording and retrieval.
Assures patient confidentiality, privacy, and health records security.
Establishes and maintains relationships with community services and providers.
Maintains current clinical knowledge base and certification.
Ability to work independently with minimal supervision.
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Stoop and bend.
Sit and/or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing.
Light lifting and carrying of files and business materials.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Nice To Haves

Insurance industry experience preferred.
Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) strongly desired at time of hire.
CCM certification required within two years of hire.

Responsibilities

Collect and assess patient information pertinent to patient’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services.
Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable.
Clinicians have direct communication among, the client, the payer, the primary care provider, and other service delivery professionals.
The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.
Interact with other PacificSource personnel to assure quality customer service is provided.
Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies.
Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients.
Practice and model effective communication skills: both written and verbal.
Utilize and promote use of evidence-based tools.
Utilize lean methodologies for continuous improvement.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.