Remote Utilization Management Clinician

PacificSource; Northern (KY); Hybrid; USD 71,000 - 106,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical insurance

Vision insurance

Dental insurance

401(k) plan

Paid time off and holidays

Tuition reimbursement and training

Life insurance

Job summary

PacificSource is seeking a nurse and behavioral health professional to coordinate care, assess member benefits, and promote effective utilization of health services. You will collaborate with physicians, nurses, social workers and other professionals to ensure high-quality, cost-effective care while maintaining thorough documentation and compliance with HIPAA and privacy policies.

The role emphasizes utilization management, case coordination, and acting as a resource for members and families,

Qualifications

• Active, unrestricted RN license required.
• Licenses in mental health fields (LPC/LMFT/LCSW/PMHNP) required or preferred.
• Case Manager Certification (CCMC) preferred.

Responsibilities

• Collect and assess member information to promote wellness and cost-effective care.
• Coordinate resources to achieve member outcome goals.
• Document case notes for legal records.

Skills

Accountability

Collaboration

Communication

Flexibility

Active listening

Organization & planning

Problem solving

Teamwork

Education

RN license

LPC

LMFT

LCSW

PMHNP credential

CCMC certification

Tools

EMR systems

ICD/CPT Codes

Job description

PacificSource is seeking a nurse and behavioral health professional to coordinate care, assess member benefits, and promote effective utilization of health services. You will collaborate with physicians, nurses, social workers and other professionals to ensure high-quality, cost-effective care while maintaining thorough documentation and compliance with HIPAA and privacy policies.

The role emphasizes utilization management, case coordination, and acting as a resource for members and families,