Care Management Clinician

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

📋 Description

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

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

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

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

• Ensure that care is delivered safely, effectively, centered around client needs, timely, efficient, and equitable.

• 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 relevant standards and guidelines.

• Deliver exceptional customer service and serve as an internal resource for questions regarding medical or contract interpretation.

• Assist employers and agents with inquiries related to healthcare resources and procedures.

• Employ and advocate for evidence-based tools.

• Apply lean methodologies to foster continuous improvement.

• Meet departmental and organizational performance and attendance standards.

• Adhere to PacificSource privacy policies as well as HIPAA laws and regulations.

• Undertake additional responsibilities 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.

• Knowledge 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.

• Understanding of contractual benefits and options available beyond those contractual benefits.

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

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

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

• Skill in establishing and maintaining relationships with community services and providers.

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

• Ability to work independently with minimal supervision.

• Proficient in reading and comprehending both written and spoken English.

• Strong ability to communicate clearly and effectively.

• Capability to stoop and bend, and to sit and/or stand for prolonged periods.

• Proficient in repetitive tasks such as typing, sorting, and filing.

• Ability to perform light lifting and carrying of files and business materials.

🏝️ Benefits

• Equal opportunity employment.

• Travel approximately 5% of the time.