Impactful Utilization Management Clinician

PacificSource Health Plans; Portland (OR); Sur place; USD 71 000 - 106 000; Plein temps

Résumé du poste

PacificSource Health Plans in Portland, Oregon seeks a qualified nurse with case management experience to coordinate care for members across medical and behavioral health services.

You will assess member needs, document case notes, and collaborate with physicians, nurses, social workers, and other professionals to promote quality, cost-effective outcomes. A license and CCMC-preferred credentials enhance candidacy.

Qualifications

• Minimum of three (3) years of nursing or behavioral health experience.
• Active, unrestricted RN license and related behavioral health credentials required.
• Ability to coordinate care and navigate health services across teams.

Responsabilités

• Collect and assess member information to promote wellness and cost-effective care.
• Coordinate resources to achieve member outcome goals.
• Document case notes and explain denotations for records.
• Perform concurrent review of inpatient and residential care.
• Identify high-cost utilization and refer to Care Management teams.
• Support internal departments with medical and contractual interpretation.

Connaissances

Nursing experience

Case management

Communication

Team collaboration

Problem solving

Formation

Active RN license

Case Manager Certification (CCMC) preferred

PMHNP/LCSW/LMFT/LPC credentials considered

Description du poste

PacificSource Health Plans in Portland, Oregon seeks a qualified nurse with case management experience to coordinate care for members across medical and behavioral health services.

You will assess member needs, document case notes, and collaborate with physicians, nurses, social workers, and other professionals to promote quality, cost-effective outcomes. A license and CCMC-preferred credentials enhance candidacy.