Care Management Clinician

PacificSource Health Plans•Springfield, OR

1d•$70,950 - $106,425

About The Position

The Care Management Clinician supports members in accessing quality, affordable care by applying professional case management practices to improve quality of life and maximize health plan benefits. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates services to meet clients’ health and human service needs. The role incorporates advocacy, communication, resource management, and cost-effective interventions, while considering physical, psychological, and cultural factors, the member’s health plan benefits, and available medical, community, and financial resources. Clinician Care Managers facilitate client wellness and autonomy through assessment, planning, communication, education, resource management, and service facilitation. They coordinate with clients, payers, providers, and other service professionals to develop individualized care plans and connect clients with appropriate services across health and human service settings. They promote safe, effective, client-centered, timely, efficient, and equitable care while protecting privacy and complying with applicable ethical, legal, accreditation, certification, and regulatory standards. The clinician also supports internal customer service by responding to medical or contractual interpretation questions and helping employers and agents understand healthcare resources and procedures. The position works inside in a general office setting with ergonomically configured equipment, and requires approximately 5% travel.

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 is 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 protect 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 read and comprehend written and spoken English and communicate clearly and effectively.

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.
Collaborate with clients and service providers to link clients with appropriate providers and resources across the continuum of health and human services and care settings.
Communicate with clients, payers, primary care providers, and other service delivery professionals.
Maintain 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 serve as an internal resource for medical or contract interpretation questions referred from other departments, physicians, and providers.
Assist employers and agents with questions about healthcare resources and procedures for their employees and clients.
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 laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.