Remote Utilization Management Clinician

PacificSource; Missouri; Hybrid; USD 71,000 - 106,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical insurance

Vision insurance

Dental insurance

Incentive program

Paid time off and holidays

401(k) plan

Tuition reimbursement and training

Life insurance

Flexible spending account

Job summary

PacificSource is seeking a qualified health services professional to coordinate care and perform utilization management for members in the United States. The role requires an RN or related clinical credential and CCMC preferred, with experience in case management and collaboration with physicians, nurses, social workers, and other professionals.

You will document care, assess benefits, identify resources, and support members and employers in navigating health services while contributing to

Qualifications

• Active, unrestricted RN license (required).
• Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or PMHNP credential required.
• Case Manager Certification (CCMC) preferred.

Responsibilities

• Collaborate with physicians, nurses and other professionals to coordinate healthcare delivery.
• Perform utilization management to promote quality and cost-effective outcomes.
• Document case notes and letters accurately for records.
• Identify high-cost utilization and coordinate with care management teams.
• Support members and families navigating health plan resources and services.
• Engage in discharge planning and coordinate post-hospitalization care.

Job description

PacificSource is seeking a qualified health services professional to coordinate care and perform utilization management for members in the United States. The role requires an RN or related clinical credential and CCMC preferred, with experience in case management and collaboration with physicians, nurses, social workers, and other professionals.

You will document care, assess benefits, identify resources, and support members and employers in navigating health services while contributing to