Care Management Clinician

Job not on LinkedIn

🔥 19 hours ago

⚔️ Virginia – Remote

⚔️ Virginia – 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 • Coordinate with clients, payers, primary care providers, and other service-delivery professionals • Maintain client privacy, confidentiality, health, and safety while adhering to ethical, legal, accreditation, certification, and regulatory standards • Answer medical or contract-interpretation questions referred by other departments, physicians, and providers • Assist employers and agents with healthcare-resource and procedure questions • Practice effective written and verbal communication • 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 confidentiality and security requirements • Perform other duties as assigned • Travel approximately 5% of the time

🎯 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 hire or within two years of hire • 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 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-record security • Ability to establish and maintain relationships with community services and providers • Ability to work independently with minimal supervision • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and lift and carry files and business materials • Insurance industry experience preferred

🏖️ Benefits

• Full-time employment • Work-from-home arrangement in Virginia • Equal opportunity and commitment to diversity, equity, inclusion, and social justice • Professional development through maintaining current clinical knowledge and certification • CCM certification may be obtained within two years of hire • At-will employment