Care Management Clinician

PacificSource•Bend, OR

About The Position

PacificSource’s Care Management Clinicians use professional case management practices to help members access quality, affordable care and achieve wellness and autonomy. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates services needed to meet clients’ health and human-service needs. Clinicians advocate for members and coordinate care while considering physical, psychological, and cultural factors, health plan benefits, and available medical, community, or financial resources. Their work promotes quality, cost-effective interventions and outcomes and helps maximize members’ quality of life and health plan benefits. Clinicians collaborate with clients, payers, primary care providers, other service professionals, and PacificSource personnel. They help ensure care is safe, effective, client-centered, timely, efficient, and equitable, while protecting client privacy, confidentiality, health, and safety in accordance with applicable ethical, legal, accreditation, certification, and regulatory standards. The position works inside in a general office setting with ergonomically configured equipment and requires travel 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 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 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 assure patient confidentiality, privacy, and health records 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 motions such as 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 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 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 service providers and based on client needs and values.
Communicate directly among clients, payers, primary care providers, and other service delivery professionals.
Protect clients’ privacy, confidentiality, health, and safety through advocacy and adherence to applicable ethical, legal, accreditation, certification, and regulatory standards or guidelines.
Interact with PacificSource personnel to support quality customer service.
Serve as an internal resource by answering referred questions requiring medical or contract interpretation, including questions from other departments, physicians, and providers of medical services and supplies.
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.