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 facilitation.

• Gather and evaluate patient information related to their history, condition, and functional abilities.

• Create detailed, personalized care management plans that promote effective and economical care utilization.

• Connect clients with suitable providers and resources across health, human services, and various care settings.

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

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

• Uphold client privacy, confidentiality, health, and safety by advocating and adhering to relevant standards and guidelines.

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

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

• Demonstrate effective written and verbal communication skills.

• Utilize and advocate for evidence-based tools.

• Implement lean methodologies for ongoing improvement.

• Meet departmental and company performance and attendance standards.

• Adhere to PacificSource privacy policies 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.

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

• Capability to effectively interact with individuals facing various health issues and concerns.

• Knowledge of contractual benefits and alternatives beyond those benefits.

• Familiarity with community services, providers, vendors, and facilities.

• Proficient in using computerized systems for data entry and retrieval.

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

• Capacity to establish and nurture relationships with community services and providers.

• Commitment to maintaining an up-to-date clinical knowledge base and certification.

• Ability to work autonomously with minimal supervision.

• Proficiency in reading and understanding written and spoken English.

• Ability to communicate clearly and effectively.

• Physical ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing, and lift and carry files and business materials.

🏝️ Benefits

• Work-from-home arrangement available in Florida.

• Travel required is approximately 5% of the time.

• Equal opportunity employment.

• Commitment to diversity, equity, inclusion, and social justice.

• At-will employment.