Care Management Clinician

PacificSource • Portland, OR

2d

About The Position

PacificSource’s Care Management Clinician supports members in accessing quality, affordable care. The role applies professional case management concepts to improve patients’ quality of life and maximize their health plan benefits. Case management involves assessing, planning, coordinating, monitoring, and evaluating services to address clients’ health and human service needs, with attention to advocacy, communication, resource management, and quality, cost-effective outcomes.

Clinician Care Managers work with clients and service providers to develop individualized plans, coordinate care and resources across health and human services, and support safe, effective, client-centered, timely, efficient, and equitable care. They communicate with clients, payers, primary care providers, and other professionals while protecting privacy, confidentiality, health, and safety. The position also provides internal and external assistance with medical or contract interpretation and healthcare resources.

The role is based inside 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

• 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 hire.
• 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.
• 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.
• Ability to read and comprehend written and spoken English and communicate clearly and effectively.
• 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 patient information about history, condition, and functional abilities to develop comprehensive, individualized care management plans that promote appropriate utilization and cost-effective care.
• Link clients with appropriate providers and resources throughout the continuum of health and human services and care settings, in collaboration with the client and service providers.
• Communicate directly with clients, payers, primary care providers, and other service delivery professionals.
• Protect clients’ 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.
• Answer referred questions from other departments, physicians, and providers 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 policies and HIPAA laws and regulations regarding the confidentiality and security of protected health information.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed