Care Management Clinician

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

📋 Description

• Advocate for client wellness and independence through 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 cost-effective care.

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

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

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

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

• Deliver exceptional customer service to PacificSource staff.

• Act as an internal resource for inquiries related to medical or contract interpretation.

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

• Utilize effective written and verbal communication skills.

• Promote and employ evidence-based tools.

• Implement lean methodologies for ongoing improvement.

• Meet departmental and company performance and attendance standards.

• Adhere to PacificSource privacy policies and HIPAA regulations.

• Perform additional duties as assigned.

⛳️ Requirements

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

• Possession of 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.

• Familiarity with health insurance and state-mandated benefits.

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

• Understanding of contractual benefits and options beyond contractual benefits.

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

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

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

• Skills to establish and maintain relationships with community services and providers.

• Commitment to maintaining current clinical knowledge and certification.

• Ability to work independently with minimal supervision.

• Proficiency in reading and understanding written and spoken English.

• Strong and effective communication abilities.

• Experience in the insurance industry is preferred.

• Demonstrated accountability, collaboration, flexibility, active listening, organizational skills, problem-solving capabilities, and teamwork.

🏝️ Benefits

• Work-from-home option (WFH: FL).

• Approximately 5% travel required.

• Commitment to equal opportunity employment.

• Support for diversity, equity, inclusion, and social justice initiatives from the employer.