Care Management Clinician

PacificSource Health Plans•WFH: FL, FL

7d•$70,950 - $106,425•Onsite

About The Position

PacificSource Care Management Clinicians facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. They assess patient history, condition, and functional abilities to develop individualized care management plans that support appropriate utilization and cost-effective care. In collaboration with clients and service providers, clinicians connect members with appropriate providers and resources across health and human services and care settings, promoting care that is safe, effective, client-centered, timely, efficient, and equitable. Clinicians communicate directly with clients, payers, primary care providers, and other professionals, safeguarding privacy, confidentiality, health, and safety while following applicable ethical, legal, accreditation, certification, and regulatory standards. They also support internal staff, physicians, providers, employers, and agents with questions involving medical or contract interpretation, healthcare resources, and procedures. The role uses evidence-based tools and lean methodologies for continuous improvement. The position works inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Physical requirements include stooping and bending, sitting and/or standing for extended periods, repetitive typing, sorting and filing, and light lifting and carrying of files and business materials.

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.
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 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 safeguard patient confidentiality, privacy, and health-record 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.
Skills in accountability, collaboration, written and verbal communication, flexibility, active listening, organization and 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 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, and develop comprehensive individualized care management plans.
Promote appropriate utilization and cost-effective care and services.
Link clients with appropriate providers and resources across the continuum of health and human services and care settings, in collaboration with clients and service providers.
Promote safe, effective, client-centered, timely, efficient, and equitable care.
Communicate with clients, payers, primary care providers, and other service delivery professionals.
Protect client privacy, confidentiality, health, and safety, and adhere to ethical, legal, accreditation, certification, and regulatory standards or guidelines.
Interact with PacificSource personnel to support quality customer service and answer questions requiring 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 policy and HIPAA confidentiality and security requirements for protected health information.
Perform other duties as assigned.