Utilization Management Clinician

PacificSource; Bend (OR); On-site; USD 70,000 - 90,000; Full time

Job summary

PacificSource seeks a qualified healthcare professional to join our Utilization Management team in Bend, Oregon. You will assess member information, coordinate resources, and support cost-effective care while ensuring quality outcomes.

Responsibilities include documenting case notes for records, performing concurrent reviews for inpatient and residential care, and maintaining collaboration with hospital staff to determine appropriate levels of care and discharge planning.

Responsibilities

• Collect and assess member information to promote wellness, appropriate utilization, and cost-effective care.
• Coordinate resources to achieve member outcome goals and objectives.
• Accurately document case notes and letters of explanation for legal records.
• Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
• Maintain contact with inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services. Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services. Facilitate outstanding member care using fiscally responsible strategies.

Essential Responsibilities

• Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services.
• Coordinate necessary resources to achieve member outcome goals and objectives.
• Accurately document case notes and letters of explanation which may become part of legal records.
• Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
• Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
• Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions.