Care Management Clinician – Team Lead

Job not on LinkedIn

🔥 13 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $83.2k - $137.3k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Manage Clinical Care Managers across assigned lines of business • Hire, train, coach, counsel, supervise, and evaluate team members • Lead development, implementation, operation, and maintenance of assigned programs, services, and functions • Monitor team workflow, caseloads, assignments, volume, timelines, accuracy, customer service, and performance measures • Improve department performance, processes, and outcomes using lean methodologies and visual boards • Orient and train new hires • Participate in hiring, promotion, and termination decisions • Assist with interdepartmental process improvement • Serve as liaison with PacificSource departments and community partners • Serve on internal and external committees and communicate pertinent information to the team • Promote and utilize evidence-based tools • Maintain a modified caseload • Investigate and resolve process-related issues and facilitate conflict resolution • Oversee and assist with service and information for members, providers, employers, agents, and other customers • Provide backup to departmental teams or management staff • Communicate updated policies, procedures, and processes to team members • Facilitate team operations, knowledge sharing, problem solving, and standardization of Health Services operations • Represent the Health Services Department internally and externally • Perform other duties as assigned

🎯 Requirements

• Minimum five years of clinical experience, including case management experience • Minimum three years of direct health plan experience in case management, utilization management, behavioral health, and/or disease/condition management strongly preferred • 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 (CCM) certification accredited by CCMC required at hire or within two years of hire • Knowledge of health insurance and state-mandated benefits • Thorough knowledge and experience in case management practice, including advocacy, assessment, planning, communication, education, resource management, and service facilitation • Effective adult education/teaching and/or group leadership skills • Strong analytical and organizational skills • Experience using information systems and computer applications • Ability to develop, review, and evaluate utilization and case management reports • Strong computer skills, including Word, Excel, and PowerPoint • Ability to use audio-visual equipment • Ability to work independently with minimal supervision • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Approximately 5% travel required • Ability to stoop, bend, sit and/or stand for extended periods, and perform repetitive typing, sorting, and filing • Ability to lift and carry files and business materials

🏖️ Benefits

• Equal opportunity employment • Work-from-home arrangement in North Carolina • Ergonomically configured equipment • Professional development through orientation, training, coaching, and ongoing education • Annual reviews and opportunities for promotion • Travel approximately 5% of the time