UM Clinician: Quality & Cost-Efficient Care Navigator

PacificSource Health Plans

Bend (OR)

On-site

USD 71,000 - 106,000

Full time

14 days+

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Job summary

PacificSource Health Plans is seeking a healthcare professional with nursing or behavioral health experience to coordinate member care and utilization management. You will collaborate with physicians, nurses, social workers and other professionals to assess benefits and coordinate services, ensuring high-quality, cost-effective outcomes.

The role requires active nursing or equivalent clinical licensure, with strong experience in case management and documentation.

Qualifications

Active RN license or equivalent clinical credential (RN, LPC, LMFT, LCSW, PMHNP) is required.
Experience in acute care, case management, rehabilitation, home health, behavioral health and hospice is strongly preferred.
Ability to work independently and as part of a cross-functional team with strong communication.

Responsibilities

Collect and assess member information to promote wellness, appropriate utilization, and cost-effective care.
Coordinate resources to achieve member outcome goals.
Document case notes and explanations for potential legal records.
Perform concurrent review of inpatients and residential programs.
Identify discharge planning needs and coordinate transfers to appropriate care settings.