Care Management Clinician

Job not on LinkedIn

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $71k - $106.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation • Collect and assess patient information to develop comprehensive, individualized care management plans • Promote appropriate utilization and cost-effective care and services • Link clients with appropriate providers and resources across health and human services and care settings • Ensure care is safe, effective, client-centered, timely, efficient, and equitable • Communicate with clients, payers, primary care providers, and other service delivery professionals • Maintain client privacy, confidentiality, health, and safety through advocacy and adherence to applicable standards and regulations • Interact with PacificSource personnel to provide quality customer service • Answer medical or contract interpretation questions referred from other departments, physicians, and providers • Assist employers and agents with healthcare resource and procedure questions • Utilize and promote evidence-based tools • Utilize lean methodologies for continuous improvement • Meet department and company performance and attendance expectations • Follow PacificSource privacy policy and HIPAA laws and regulations • Perform other duties as assigned

🎯 Requirements

• Minimum of three (3) 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 required • Certified Case Manager Certification (CCM) accredited by CCMC required at time of hire or within two years of 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 • Knowledge of contractual benefits and options available outside contractual benefits • Knowledge of community services, providers, vendors and facilities • Ability to use computerized systems for data recording and retrieval • Ability to maintain patient confidentiality, privacy, and health records security • Ability to establish and maintain relationships with community services and providers • Ability to maintain current clinical knowledge base and certification • Ability to work independently with minimal supervision • Ability to read and comprehend both written and spoken English • Ability to communicate clearly and effectively • Stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting and filing; light lifting and carrying

🏖️ Benefits

• Equal opportunity employment • Work inside a general office setting with ergonomically configured equipment • Travel approximately 5% of the time