Care Management Clinician
About The Position
The Care Management Clinician uses professional case management practices to support members’ quality of life and help them maximize their health plan benefits. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates services and options addressing clients’ health and human service needs. It includes advocacy, communication, resource management, and the promotion of quality, cost-effective interventions and outcomes. Clinicians coordinate healthcare services while considering physical, psychological, and cultural factors; assess health plan benefits; and identify additional medical, community, or financial resources. They work with clients and service providers to support safe, effective, client-centered, timely, efficient, and equitable care across health and human services and care settings. The role also provides internal support and answers questions involving medical or contract interpretation, healthcare resources, and procedures. The position is based inside a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. The role requires a minimum of three years of clinical experience, including case management. An active, unrestricted RN license, LPC, LMFT, or LCSW credential is required. CCM certification is required at hire or within two years of the hire date. The stated base salary range is $70,950.00–$106,424.99; actual compensation depends on factors including qualifications, experience, education, and internal equity.
Requirements
- Minimum of three years of clinical experience, including case management.
- 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 deal 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 assure patient confidentiality, privacy, and health records security.
- Ability to establish and maintain relationships with community services and providers.
- Ability to maintain a current clinical knowledge base and certification.
- Ability to work independently with minimal supervision.
- Skills in accountability, collaboration, written and verbal communication, flexibility, active listening, organization, planning, problem solving, and teamwork.
- Ability to stoop and bend; sit and/or stand for extended periods; perform repetitive motions including typing, sorting, and filing; and lift and carry files and business materials lightly.
- Ability to read and comprehend written and spoken English and communicate clearly and effectively.
Nice To Haves
- Insurance industry experience preferred.
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 and services.
- Link clients with appropriate providers and resources throughout the continuum of health and human services and care settings, based on client needs and values and in collaboration with service providers.
- Communicate among clients, payers, primary care providers, and other service delivery professionals.
- Protect client privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines.
- Interact with PacificSource personnel to support quality customer service and serve as an internal resource for questions requiring medical or contract interpretation.
- 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 laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
