UM Clinician: Elevating Access to Care

PacificSource; Bend (OR); On-site; USD 71,000 - 106,000; Full time

Benefits offered by this job

Flexible telecommute

Medical

Vision

Dental

Incentive program

PTO and holidays

401(k) plan

Volunteer opportunities

Tuition reimbursement and training

Life insurance

Flexible spending account

Job summary

PacificSource is seeking a qualified health services professional to coordinate care across physicians, nurses, social workers, and other professionals. The role emphasizes utilization management, documentation, and collaboration to promote high-quality, cost-effective care.

Minimum three years of nursing or behavioral health experience is required, with relevant licenses such as RN, LPC, LMFT, LCSW or PMHNP.

Qualifications

• Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, ICD/CPT codes and health insurance benefits.
• Understanding of contractual benefits and options outside contractual benefits.
• Working knowledge of community services, providers, vendors and facilities available to assist members.

Responsibilities

• Collect and assess member information to promote wellness, appropriate utilization and cost-effective care.
• Coordinate necessary resources to achieve member outcome goals.
• Accurately document case notes and explain letters that may become legal records.
• Perform concurrent review of members in inpatient or residential care settings.
• Maintain contact with inpatient utilization review to ensure appropriate level of care.
• Identify discharge planning needs including transfers to SNF, rehab, or home health.
• Review referrals for appropriateness using evidence-based criteria.
• Identify and negotiate with vendors to provide services when applicable.
• Negotiate discounts with non-contracted providers for contract development.
• Collaborate with multidisciplinary teams to support members and navigate networks.
• Serve as a primary resource to members and families for questions about health plan and system navigation.
• Answer questions requiring medical or contract interpretation referred from other departments.
• Assist employers and agents with healthcare resources questions.
• Identify high-cost utilization and refer to Large Case Reinsurance RN and Care Management.
• Assist Medical Director in developing guidelines for Health Services.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Organizational skills

Problem Solving

Teamwork

Education

RN license

LPC

LMFT

LCSW

PMHNP

CCM certification

Job description

PacificSource is seeking a qualified health services professional to coordinate care across physicians, nurses, social workers, and other professionals. The role emphasizes utilization management, documentation, and collaboration to promote high-quality, cost-effective care.

Minimum three years of nursing or behavioral health experience is required, with relevant licenses such as RN, LPC, LMFT, LCSW or PMHNP.