Care Management Clinician

This is a fully remote position, open to applicants in Florida.

📋 Description

• Support client wellness and independence through advocacy, assessment, planning, communication, education, resource management, and service coordination.

• Gather and evaluate patient information to create detailed, personalized care management plans.

• Encourage the appropriate use of services and cost-effective care.

• Connect clients with suitable providers and resources across health and human services and care environments.

• Ensure that care is safe, effective, client-focused, timely, efficient, and fair.

• Engage in communication with clients, payers, primary care providers, and other professionals involved in service delivery.

• Safeguard client privacy, confidentiality, health, and safety through advocacy and compliance with ethical, legal, accreditation, certification, and regulatory standards.

• Deliver exceptional customer service to PacificSource personnel.

• Address medical or contract interpretation inquiries referred by other departments, physicians, and providers.

• Assist employers and agents with inquiries regarding healthcare resources and procedures.

• Employ effective written and verbal communication skills.

• Advocate for the use of evidence-based tools.

• Apply lean methodologies to promote continuous improvement.

• Fulfill department and company performance and attendance standards.

• Adhere to PacificSource privacy policy and HIPAA laws and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of three (3) years of clinical experience, including case management.

• An active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) credential is required.

• Certified Case Manager Certification (CCM) accredited by CCMC is required at the time of hire or within two years of the hire date.

• Understanding of health insurance and state-mandated benefits.

• Experience and proficiency in case management practices, including advocacy, assessment, planning, communication, education, resource management, and service facilitation.

• Familiarity with contractual benefits and options outside those benefits.

• Knowledge of community services, providers, vendors, and facilities.

• Capability to utilize computerized systems for data entry and retrieval.

• Ability to maintain patient confidentiality, privacy, and security of health records.

• Current clinical knowledge and certification.

• Ability to work independently with minimal supervision.

• Proficiency in reading and understanding written and spoken English.

• Ability to communicate clearly and effectively.

• Experience in the insurance industry is preferred.

🏝️ Benefits

• Work-from-home location designated as WFH: FL.

• Travel is approximately 5% of the time.

• Equal opportunity employment.

• At-will employment.