Care Management Clinician

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🕒 3 days ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $71k - $106.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

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

• Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. • Collect and assess patient information pertinent to the patient’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services. • Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. • Clinicians have direct communication among the client, the payer, the primary care provider, and other service delivery professionals. • The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines. • Interact with other PacificSource personnel to assure quality customer service is provided. • Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. • Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients. • Practice and model effective communication skills: both written and verbal. • Utilize and promote use of evidence-based tools. • Utilize lean methodologies for continuous improvement.

🎯 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) as accredited by CCMC (The Commission for Case Management) also 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. • Ability to deal effectively with people who have various health issues and concerns. • Knowledge and understanding 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. • Assures patient confidentiality, privacy, and health records security. • Establishes and maintains relationships with community services and providers. • Maintains current clinical knowledge base and certification. • Ability to work independently with minimal supervision.

🏖️ Benefits

• Flexible telecommute policy • medical, vision, and dental insurance • incentive program • paid time off and holidays • 401(k) plan • volunteer opportunities • tuition reimbursement and training • life insurance • options such as a flexible spending account