Care Management Clinician
About The Position
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet clients’ health and human service needs. It involves advocacy, communication, and resource management to promote quality, cost-effective interventions and outcomes. Clinicians apply professional case management practices to enhance patients’ quality of life and maximize health plan benefits, considering healthcare services, physical, psychological, and cultural factors, health plan benefits, and available medical, community, and financial resources. Clinician Care Managers support client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. They collect and assess patient information to develop individualized care management plans, connect clients with appropriate providers and resources, and coordinate care across health and human service settings. They communicate with clients, payers, primary care providers, and other professionals while maintaining privacy, confidentiality, health, and safety and adhering to applicable standards and guidelines. The role also supports customer service across PacificSource, provides internal guidance on medical or contract interpretation, and assists employers and agents with healthcare resource and procedure questions. Clinicians use evidence-based tools and lean methodologies for continuous improvement. The work is performed inside in a general office setting with ergonomically configured equipment; travel is required approximately 5% of the time.
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 hire.
- Knowledge of health insurance and state-mandated benefits.
- Experience and expertise in case management practices, 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 maintain 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.
- Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions such as typing, sorting, and filing, and lift and carry files and business materials.
Nice To Haves
- Insurance industry experience is preferred.
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 across health and human services and care settings, based on client needs and values and in collaboration with service providers.
- Communicate with 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 provide internal guidance on medical or contract interpretation.
- Assist employers and agents with questions about healthcare resources and procedures for their employees and clients.
- Practice 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 requirements regarding 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
