Impactful Utilization & Care Management Clinician

pacificsource; Utah; Hybrid; USD 65,000 - 90,000; Full time

Job summary

PacificSource seeks a health services professional with RN or behavioral health credentials to support member care coordination and utilization review. The role emphasizes case management, documentation, and multidisciplinary collaboration within a health plan framework.

Required are an active RN license or equivalent credential and substantial experience in acute care, rehab, home health, or hospice; CCMC certification is preferred for advancement.

Qualifications

• Minimum of three (3) years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required.
• Active, unrestricted RN license, LPC, LMFT, LCSW or PMHNP credential required.
• Case Manager Certification (CCMC) preferred.
• Acute care and case management experience including rehabilitation, home health, behavioral health and hospice strongly preferred.

Responsibilities

• Collect and assess member information pertinent to history, condition, and functional abilities to promote wellness and cost-effective care.
• Coordinate necessary resources to achieve member outcomes and objectives.
• Accurately document case notes and letters which may become part of legal records.
• Perform concurrent review of inpatients, residential treatment centers, and partial hospitalization programs.
• Maintain contact with inpatient facility utilization review personnel to ensure appropriateness of continued stay and level of care.

Skills

Nursing experience

Behavioral health experience

Case management

Communication skills

Education

RN licensure

LPC

LMFT

LCSW

PMHNP credential

CCMC Case Manager Certification

Job description

PacificSource seeks a health services professional with RN or behavioral health credentials to support member care coordination and utilization review. The role emphasizes case management, documentation, and multidisciplinary collaboration within a health plan framework.

Required are an active RN license or equivalent credential and substantial experience in acute care, rehab, home health, or hospice; CCMC certification is preferred for advancement.