Impact-Driven Utilization Management Clinician

PacificSource; Portland (OR); On-site; USD 71,000 - 106,000; Full time

Job summary

PacificSource in Portland, OR is seeking an Utilization Management Clinician (full-time) to join our team Tue-Sat. The role requires RN or related license and a minimum of 3 years in nursing or behavioral health to coordinate care for members.

You will assess benefits, coordinate resources, document case notes, and perform concurrent reviews across inpatient, residential, and partial hospitalization settings while collaborating with physicians, nurses, social workers and the care team.

Qualifications

• Minimum of three years nursing or behavioral health experience.
• Active, unrestricted RN license or equivalent (LPC/LMFT/LCSW/PMHNP) required.
• Case Manager Certification (CCMC) preferred.

Responsibilities

• Collect and assess member information to promote wellness, utilization, and cost-effective care.
• Coordinate resources to achieve member outcome goals.
• Accurately document case notes and explanations for records.
• Perform concurrent reviews for inpatient facilities, residential centers, and partial hospitalization.
• Maintain contact with inpatient utilization review personnel to assure appropriate stay level of care.
• Identify discharge planning needs including transfers to skilled nursing, rehab, residential, and outpatient services.
• Review referrals and preauthorizations for appropriateness of care within established criteria.
• Collaborate with multidisciplinary teams to support members and processes.
• Serve as internal resource for medical or contract interpretation.

Skills

Nursing

Behavioral health

Case management

Documentation

Collaboration

Communication

Adaptability

Teamwork

Education

RN license

CCMC certification (preferred)

LPC/LMFT/LCSW/PMHNP credential

Tools

ICD/CPT codes

Job description

PacificSource in Portland, OR is seeking an Utilization Management Clinician (full-time) to join our team Tue-Sat. The role requires RN or related license and a minimum of 3 years in nursing or behavioral health to coordinate care for members.

You will assess benefits, coordinate resources, document case notes, and perform concurrent reviews across inpatient, residential, and partial hospitalization settings while collaborating with physicians, nurses, social workers and the care team.