Impactful Utilization Management Clinician - Remote

PacificSource; South Carolina; Hybrid; USD 71,000 - 106,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

401(k) plan

Paid time off & holidays

Tuition reimbursement

Life insurance

Flexible spending account

Job summary

PacificSource is seeking a dedicated Health Services professional to oversee utilization management and coordinate care for members in South Carolina. This role partners with physicians, nurses, social workers, and other professionals to ensure quality and cost-effective outcomes.

The ideal candidate holds an RN license with case management experience and a strong understanding of medical and behavioral health processes, ICD/CPT coding, and HIPAA compliance. Travel ~5% is required.

Qualifications

• Active, unrestricted RN license or equivalent credential required.
• Experience in nursing or behavioral health with care coordination and utilization management.
• Knowledge of ICD/CPT codes, health benefits, and state regulations.

Responsibilities

• Collect and assess member information to promote wellness and cost-effective care.
• Coordinate resources to achieve member outcome goals and objectives.
• Document case notes and explanations for records.
• Perform concurrent review of inpatients and treatment programs.
• Identify discharge planning needs and coordinate transitions.

Skills

Accountability

Collaboration

Communication

Problem solving

Teamwork

Adaptability

Relationship building

Education

RN license

CCMC preferred

Job description

PacificSource is seeking a dedicated Health Services professional to oversee utilization management and coordinate care for members in South Carolina. This role partners with physicians, nurses, social workers, and other professionals to ensure quality and cost-effective outcomes.

The ideal candidate holds an RN license with case management experience and a strong understanding of medical and behavioral health processes, ICD/CPT coding, and HIPAA compliance. Travel ~5% is required.