UM Clinician: Care Coordination & Quality Outcomes

PacificSource Health Plans; Springfield (OR); On-site; USD 71,000 - 106,000; Full time

Job summary

PacificSource Health Plans seeks an experienced health services professional to coordinate care across physicians, nurses, social workers and other providers. You will assess member benefits, promote appropriate utilization, and help translate complex health plans into practical care guidance.

Essential duties include collecting member information, documenting case notes, performing concurrent reviews, coordinating resources, and supporting discharge planning.

Qualifications

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

Responsibilities

• Coordinate utilization management and care coordination across teams.
• Document case notes and communicate plan of care clearly.
• Review referrals and preauthorizations for appropriateness.
• Identify high-cost utilization and collaborate on discharge planning.
• Support members with healthcare resources and contract interpretation.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organization

Problem Solving

Teamwork

Education

RN license

LPC

LMFT

LCSW

PMHNP credential

CCMC preferred

Job description

PacificSource Health Plans seeks an experienced health services professional to coordinate care across physicians, nurses, social workers and other providers. You will assess member benefits, promote appropriate utilization, and help translate complex health plans into practical care guidance.

Essential duties include collecting member information, documenting case notes, performing concurrent reviews, coordinating resources, and supporting discharge planning.