Impactful UM Clinician: Care Coordination Expert

PacificSource; United States; Remote; USD 71,000 - 106,000; Full time

Job summary

PacificSource seeks a qualified care coordination professional to support members with medical and behavioral health needs. The role focuses on utilization management, care planning, and collaboration with physicians, nurses, social workers, and other professionals to promote quality, cost-effective care.

Active RN license and behavioral health credentials are required, with CCMC preferred. The position emphasizes documentation, criteria-based reviews, and coordinating services across care

Qualifications

• Active RN license and behavioral health credential are required.
• Experience coordinating care across medical and behavioral health teams.
• Familiarity with ICD/CPT coding and health plan benefits is expected.

Responsibilities

• Collect member information to support wellness and appropriate utilization.
• Coordinate resources to reach member outcome goals.
• Document case notes and explanations for records and potential legal use.
• Perform concurrent review for inpatients and treatment programs.
• Maintain contact with facilities to ensure appropriate level of care.
• Identify discharge planning needs and community resources as needed.
• Review referrals for appropriateness against established criteria.
• Negotiate with providers and non-contracted vendors when applicable.
• Collaborate with multidisciplinary teams to support member care.
• Serve as a resource for member questions regarding health plans.

Skills

Team collaboration

Communication skills

Care coordination

Documentation

Education

Active RN license

LPC/LMFT/LCSW/PMHNP credential

CCMC Certification preferred

Job description

PacificSource seeks a qualified care coordination professional to support members with medical and behavioral health needs. The role focuses on utilization management, care planning, and collaboration with physicians, nurses, social workers, and other professionals to promote quality, cost-effective care.

Active RN license and behavioral health credentials are required, with CCMC preferred. The position emphasizes documentation, criteria-based reviews, and coordinating services across care