Impact-Driven Utilization Management Clinician

PacificSource; Springfield (OR); On-site; USD 54,000 - 78,000; Full time

Job summary

PacificSource is seeking a health care utilization management professional to collaborate with physicians, nurses, social workers and other providers to coordinate care and assess member health plan benefits. You will facilitate utilization management aiming for quality and cost-effective outcomes and document case notes.

Responsibilities include collecting member information, coordinating resources to achieve outcomes, documenting case notes, and conducting concurrent reviews in inpatient or

Responsibilities

• Collect and assess member information pertinent to member's history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services.
• Coordinate necessary resources to achieve member outcome goals and objectives.
• Accurately document case notes and letters of explanation which may become part of legal records.
• Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
• Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
• Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions.

Job description

PacificSource is seeking a health care utilization management professional to collaborate with physicians, nurses, social workers and other providers to coordinate care and assess member health plan benefits. You will facilitate utilization management aiming for quality and cost-effective outcomes and document case notes.

Responsibilities include collecting member information, coordinating resources to achieve outcomes, documenting case notes, and conducting concurrent reviews in inpatient or