Care Management Clinician

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

📋 Description

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

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

• Encourage appropriate utilization of services and cost-effective care.

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

• Collaborate with clients, payers, primary care providers, and other service-delivery professionals.

• Ensure client privacy, confidentiality, health, and safety while complying with ethical, legal, accreditation, certification, and regulatory standards.

• Address medical or contract-related inquiries directed by other departments, physicians, and providers.

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

• Demonstrate effective written and verbal communication skills.

• Utilize and advocate for evidence-based tools.

• Apply lean methodologies for ongoing improvement.

• Achieve department and company performance and attendance standards.

• Adhere to PacificSource privacy policy and HIPAA confidentiality and security requirements.

• Perform additional duties as assigned.

• Travel is required approximately 5% of the time.

⛳️ 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 hire or within two years of hire.

• 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.

• Knowledge of contractual benefits and alternative options outside of contractual benefits.

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

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

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

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

• Ability to work independently with minimal supervision.

• Proficiency in reading and understanding written and spoken English.

• Capacity to communicate clearly and effectively.

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

• Insurance industry experience is preferred.

🏝️ Benefits

• Full-time employment.

• Work-from-home arrangement available in Virginia.

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

• Opportunities for professional development through maintaining current clinical knowledge and certification.

• CCM certification can be obtained within two years of hire.

• At-will employment.