Care Management Clinician (Monday-Friday)

PacificSource; Virginia (MN); Hybrid; USD 71,000 - 106,000; Full time

Job summary

PacificSource is seeking a Clinician Care Manager to support member wellness and autonomy through advocacy, assessment, planning, and service facilitation. You will coordinate with providers and resources to ensure safe, equitable, and cost-effective care while protecting privacy.

The role requires an active RN, LPC, LMFT, or LCSW license, CCM certification within two years, and strong communication skills in a fast-paced, at-will environment.

Qualifications

• Active, unrestricted RN license, LPC, LMFT, or LCSW credential required.
• CCM certification required at time of hire or within two years.

Responsibilities

• Collect and assess patient information to develop a comprehensive care management plan that promotes appropriate utilization and cost-effective care.
• Link clients with providers and resources across the continuum of health and human services.
• Maintain client privacy, confidentiality, health, and safety through advocacy and adherence to ethical and regulatory standards.
• Interact with PacificSource personnel to assure quality customer service and act as an internal resource for medical or contract interpretation.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organization

Problem Solving

Teamwork

Education

RN license (Active, unrestricted)

LPC

LMFT

LCSW

CCM Certification

Tools

Electronic Health Records (EHR) systems

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Essential Responsibilities:

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 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.

Supporting Responsibilities:

Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of three (3) years of clinical experience, including case management. Insurance industry experience preferred.

Education, Certificates, Licenses:

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:

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.

Competencies

Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment:

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range: $70,950.00 - $106,424.99

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.