Care Management Clinician

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

📋 Description

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

• Gather and evaluate patient data to create detailed, personalized care management strategies.

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

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

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

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

• Uphold client privacy, confidentiality, health, and safety in compliance with relevant standards and regulations.

• Address medical or contract interpretation inquiries from internal departments, physicians, and providers.

• Support employers and agents with questions regarding healthcare resources and procedures.

• Utilize evidence-based tools and lean methodologies for ongoing improvement.

• Meet departmental and company performance and attendance standards.

• Adhere to PacificSource privacy policies and HIPAA regulations.

• Execute additional responsibilities as assigned.

⛳️ Requirements

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

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

• Certification as a Certified Case Manager (CCM) accredited by CCMC is required upon hire or within two years of the start date.

• Familiarity with health insurance and state-mandated benefits.

• Proven experience and proficiency in case management practices.

• Understanding of contractual benefits and options outside of those benefits.

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

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

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

• Proficiency in working independently with minimal oversight.

• Capacity to read and understand written and spoken English.

• Skill in communicating clearly and effectively.

• Physical ability to stoop, bend, sit and/or stand for prolonged periods, perform repetitive motions, and lift and carry files and business materials.

🏝️ Benefits

• Full-time employment.

• Work-from-home option.

• Commitment to equal opportunity employment.

• Travel is required approximately 5% of the time.