UM Clinician: Care Coordination & Outcomes Advocate

PacificSource Health Plans; Columbia (SC); Presencial; USD 71.000 - 106.000; Jornada completa

Descripción de la vacante

PacificSource Health Plans in Columbia, South Carolina is seeking a qualified RN- or behavioral health–certified professional to help members access quality, affordable care. This role supports utilization management and collaborates with physicians, nurses, social workers and other professionals to coordinate services.

The successful candidate will assess benefits, promote cost‑effective outcomes, document care, and engage with multidisciplinary teams to improve member experience.

Formación

• Active, unrestricted RN license or equivalent credential required.
• Experience in nursing or behavioral health with case management preferred.
• Knowledge of ICD/CPT codes, health insurance benefits, and care planning processes.

Responsabilidades

• Collect member information to promote wellness and appropriate care.
• Coordinate resources to achieve member outcome goals.
• Document case notes and explanations for records.
• Perform concurrent review of inpatient stays.
• Identify discharge planning needs and coordinate transitions.
• Review referrals and preauthorization for care accuracy.
• Negotiate with vendors to provide services when applicable.

Conocimientos

Accountability

Collaboration

Communication

Flexibility

Active Listening

Organizational Skills

Problem Solving

Teamwork

Educación

RN License

PMHNP

LCSW

Descripción del empleo

PacificSource Health Plans in Columbia, South Carolina is seeking a qualified RN- or behavioral health–certified professional to help members access quality, affordable care. This role supports utilization management and collaborates with physicians, nurses, social workers and other professionals to coordinate services.

The successful candidate will assess benefits, promote cost‑effective outcomes, document care, and engage with multidisciplinary teams to improve member experience.