Care Management Clinician

PacificSource Health Plans•WFH: TN, TN

3d•$70,950 - $106,425

About The Position

The Care Management Clinician supports members in accessing quality, affordable care through professional case management. 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 promotes advocacy, communication, resource management, quality outcomes, and cost-effective interventions. Clinicians coordinate healthcare services while considering physical, psychological, and cultural factors, patient health-plan benefits, and available medical, community, or financial resources. Clinicians facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. They work with clients and service providers across health and human-service settings, while protecting client privacy, confidentiality, health, and safety and following applicable ethical, legal, accreditation, certification, and regulatory standards. The role also supports customer service across PacificSource, applies evidence-based tools and lean methodologies, and works 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 RN license, LPC, LMFT, or 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 practices, including advocacy, assessment, planning, communication, education, resource management, and service facilitation.
Ability to work effectively with people who have varied health issues and concerns.
Knowledge of contractual benefits and options available outside contractual benefits.
Knowledge of community services, providers, vendors, and facilities that can 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 and planning, problem solving, and teamwork.
Ability to stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting, and filing; and lift and carry files and business materials.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

Insurance industry experience.

Responsibilities

Assess patient information, history, condition, 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 service providers and based on client needs and values.
Communicate directly with clients, payers, primary care providers, and other service-delivery professionals.
Advocate for clients and protect their privacy, confidentiality, health, and safety while following applicable ethical, legal, accreditation, certification, and regulatory standards or guidelines.
Interact with PacificSource personnel to support quality customer service and answer referred questions requiring medical or contract interpretation.
Assist employers and agents with questions about healthcare resources and procedures for their employees and clients.
Use and model effective written and verbal communication skills.
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 concerning the confidentiality and security of protected health information.
Perform other duties as assigned.