Care Management Clinician

PacificSource•Boise, ID

About The Position

PacificSource is seeking a Care Management Clinician to help members access quality, affordable care. The role uses professional case management practices to assess, plan, coordinate, monitor, and evaluate services that address clients’ health and human-service needs. Clinicians advocate for clients, communicate with care partners, manage resources, and promote quality, cost-effective outcomes while considering physical, psychological, and cultural factors, health plan benefits, and available medical, community, and financial resources. The clinician works with clients and service providers across health and human services and care settings to support wellness and autonomy. The role includes interpreting medical or contractual questions, supporting employers and agents with healthcare-resource questions, using evidence-based tools, and contributing to continuous improvement. The position works in a general office setting with ergonomically configured equipment and requires approximately 5% travel.

Requirements

At least three years of clinical experience, including case management.
An active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) credential.
Certified Case Manager (CCM) certification accredited by CCMC, required at hire or within two years of the hire date.
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 work effectively with people who have various health issues and concerns.
Knowledge 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.
Ability to safeguard patient confidentiality, privacy, and health-record security.
Ability to establish and maintain relationships with community services and providers.
Ability to maintain current clinical knowledge and certification.
Ability to work independently with minimal supervision.
Skills in accountability, collaboration, written and verbal communication, flexibility, active listening, organization and planning, problem solving, and teamwork.

Nice To Haves

Insurance industry experience.

Responsibilities

Facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation.
Collect and assess information about patients’ histories, conditions, and functional abilities to develop individualized care management plans that promote appropriate utilization and cost-effective care.
Link clients with appropriate providers and resources across health and human services and care settings, in collaboration with clients and service providers.
Communicate directly with clients, payers, primary care providers, and other service-delivery professionals.
Protect clients’ privacy, confidentiality, health, and safety by adhering to ethical, legal, accreditation, certification, and regulatory standards or guidelines.
Interact with PacificSource personnel to support quality customer service.
Serve as an internal resource by answering referred questions requiring medical or contract interpretation, including questions from other departments, physicians, and providers of medical services and supplies.
Assist employers and agents with questions about healthcare resources and procedures for their employees and clients.
Practice and model effective written and verbal communication.
Use and promote evidence-based tools.
Use lean methodologies for continuous improvement.
Meet department and company performance and attendance expectations.
Follow PacificSource privacy policy and HIPAA requirements concerning confidentiality and security of protected health information.
Perform other duties as assigned.