Care-Driven Utilization Management Clinician

PacificSource; Orangeburg (SC); Sur place; USD 71 000 - 106 000; Plein temps

Résumé du poste

PacificSource in the United States is seeking an experienced nursing or behavioral health professional to coordinate member care, perform utilization management, and collaborate with a multidisciplinary team to promote high-quality, cost-effective outcomes.

The role requires an active RN license or equivalent, knowledge of ICD/CPT codes, and strong communication skills. Travel about 5% is expected; this position offers a competitive base pay and a supportive, values-driven culture.

Qualifications

• : Active, unrestricted RN license or equivalent required.
• : Experience in medical/behavioral health and case management preferred.
• : Knowledge of ICD/CPT codes and health insurance benefits and options.

Responsabilités

• Collect and assess member information to promote wellness and cost-effective care.
• Coordinate resources to achieve member outcome goals.
• Document case notes and letters that may become part of legal records.
• Perform concurrent review of inpatients, residential treatment centers and partial hospitalization programs.
• Identify high cost utilization and refer to care management teams.
• Follow HIPAA privacy laws and confidentiality standards.

Connaissances

Nursing

Case management

Communication

Collaboration

HIPAA compliance

Formation

RN license

LPC

LMFT

LCSW

PMHNP credential

CCMC certification

Description du poste

PacificSource in the United States is seeking an experienced nursing or behavioral health professional to coordinate member care, perform utilization management, and collaborate with a multidisciplinary team to promote high-quality, cost-effective outcomes.

The role requires an active RN license or equivalent, knowledge of ICD/CPT codes, and strong communication skills. Travel about 5% is expected; this position offers a competitive base pay and a supportive, values-driven culture.