Utilization Management Clinician - Part-Time RN (Monday - Friday)

PacificSource; Springfield (OR); On-site; USD 50,000 - 80,000; Part time

Job summary

Join a forward-thinking company as a Utilization Management Clinician, where you will play a vital role in ensuring quality, affordable healthcare for members. This part-time position offers the opportunity to collaborate with a diverse team of healthcare professionals to coordinate services and promote effective utilization of healthcare resources. Be part of a mission-driven organization that values diversity, community, and personal growth, while enjoying competitive wages and a supportive work environment that encourages work-life balance. If you are passionate about making a difference in healthcare, this role is for you.

Benefits

Flexible telecommute policy

Medical, vision, and dental insurance

Paid time off and holidays

401(k) plan

Tuition reimbursement

Life insurance

Qualifications

• Minimum of three years of nursing or behavioral health experience required.
• Experience in acute care and case management preferred.

Responsibilities

• Collect and assess member information for wellness and cost-effective care.
• Coordinate resources to achieve member outcome goals.
• Perform concurrent reviews of inpatient admissions.

Skills

Nursing

Behavioral Health

Case Management

Documentation

Communication

Problem Solving

Collaboration

Education

Registered Nurse License

Case Manager Certification

Job description

Utilization Management Clinician - Part-Time RN (Monday - Friday) page is loaded

Utilization Management Clinician - Part-Time RN (Monday - Friday)

Apply locations Springfield, OR time type Part time posted on Posted 2 Days Ago job requisition id 2025-741

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.

Qualified candidates must be acceptable to a 20 hour/week Monday - Friday work schedule

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.
• Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.
• When applicable, identify and negotiate with appropriate vendors to provide services.
• When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development.
• Work with multidisciplinary teams utilizing an integrated team-based approach to best support members, which may include working together on network not available (NNA), out of network exceptions (OONE), and one-time agreements (OTA).
• Serve as primary resource to member and family members for questions and concerns related to the health plan and in navigating through the health systems issues.
• Interact with other PacificSource personnel to assure quality customer service is provided.
• Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies.
• Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients.
• Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate.
• Assist Medical Director in developing guidelines and procedures for Health Services Department.

Supporting Responsibilities:

• Act as backup and be a resource for other Health Services Department staff and functions as needed.
• Serve on designated committees, teams, and task groups, as directed.
• Represent the Heath Services Department, both internally and externally, as requested by Medical Director.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of three (3) years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required. Experience in acute care, case management, including cases that require rehabilitation, home health, behavioral health and hospice treatment strongly preferred. Insurance industry experience helpful, but not required.

Education, Certificates, Licenses: Registered Nurse or a clinically licensed behavioral health practitioner with current unrestricted state license. Within six (6) months of hire licensure may need to include Oregon, Montana, Idaho and/or other states as needed. Case Manager Certification as accredited by CCMC preferred.

Knowledge: Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance and state-mandated benefits. Understanding of contractual benefits and options available outside contractual benefits. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of appropriate case management plans. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision. Must be able to function as part of a collaborative, cohesive community.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington.

It's our 1,800+ employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement.

Benefits: F lexible telecommute policy, m edical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.

Why PacificSource

We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about:

• A mission with a real sense of shared values
• Competitive wages and outstanding benefits, including telecommuting
• Opportunities for learning development and career advancement
• Organizational leadership style rooted in servant and transformational leadership
• A commitment to support the communities we serve
• A belief in the importance of work-life balance

Upcoming career fairs

April 10: Central Oregon Community College Spring Job Fest , 10a -1p, Bend Campus (2600 NW College Way, Bend, OR)

April 15: Central Oregon Community College Spring Job Fest, 10a-1p, Redmond Campus (2030 SE College Loop, Redmond, OR)

April 23: University of Oregon Healthcare Career Fair, 11a-2p, University Career Center (1305 University Street, Eugene, OR)

April 30: Linn Benton Community College Career Fair, 10a-2p, (6500 Pacific Blvd SW, Albany, OR)

Grow your career with us

PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2023 alone we had 407 internal promotions!

Recognitions

Top Workplace 2024 and 2025 USA | USA Today

Top Workplace 2024, 2023 and 2022 for Oregon and SW Washington | The Oregonian

Top Workplace 2024, 2023 and 2022 for Boise and the Treasure Valley | Idaho Press

Certified Age Friendly Employer, 2023 | Age Friendly Institute

#4 Healthiest Employer of Oregon 2021 | Portland Business Journal

Affirmative Action Program Policy Statement

PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement.