Care Management Clinician

PacificSource Health Plans•Portland, OR

1d•$70,950 - $106,425•Onsite

About The Position

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet clients’ health and human service needs. It uses advocacy, communication, and resource management to promote quality, cost-effective interventions and outcomes. Clinicians apply professional case management concepts to improve patients’ quality of life and maximize health plan benefits, including coordinating healthcare services, considering physical, psychological, and cultural factors, assessing health plan benefits, and identifying medical, community, and financial resources. Clinician Care Managers facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. They coordinate with clients and service providers across health and human services and care settings, and communicate with clients, payers, primary care providers, and other professionals. They also support PacificSource personnel, employers, agents, physicians, and providers with medical, contractual, and healthcare-resource questions. The position promotes privacy, confidentiality, safety, evidence-based tools, effective communication, and continuous improvement using lean methodologies. The role works inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. The stated base salary range is $70,950.00–$106,424.99; actual compensation depends on qualifications, experience, education, and internal equity.

Requirements

At least 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 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 ensure 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, planning, problem solving, and teamwork.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

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 the continuum of health and human services and care settings, collaborating with service providers and considering client needs and values.
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 medical or contract interpretation questions referred by other departments, physicians, and providers.
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.