Care Management Clinician

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

📋 Description

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

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

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

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

• Coordinate communication among clients, payers, primary care providers, and various service professionals.

• Safeguard client privacy, confidentiality, health, and safety through advocacy and compliance with relevant standards and regulations.

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

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

• Utilize and promote 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.

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

• Familiarity with contractual benefits and options available outside of contractual benefits.

• Knowledge of community services, providers, vendors, and facilities available to support members.

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

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

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

• A current clinical knowledge base and certification.

• Ability to work independently with minimal supervision.

• Proficiency in reading and understanding both written and spoken English.

• Capacity to communicate clearly and effectively.

• Insurance industry experience is preferred.

🏝️ Benefits

• Equal opportunity employment.

• Work-from-home arrangement.

• Ergonomically configured equipment.

• Opportunities for professional case management and clinical knowledge advancement.

• Travel approximately 5% of the time.

• Eligibility for Certified Case Manager Certification (CCM) at the time of hire or within two years of the hire date.