Care Management Clinician

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

📋 Description

• Facilitate client wellness and independence by means of 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 as well as cost-effective care and services.

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

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

• Directly communicate with clients, payers, primary care providers, and other service professionals.

• Safeguard client privacy, confidentiality, health, and safety by adhering to ethical, legal, accreditation, certification, and regulatory standards.

• Collaborate with PacificSource personnel to deliver high-quality customer service.

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

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

• Exhibit effective written and verbal communication skills.

• Utilize and advocate for evidence-based tools.

• Apply lean methodologies for ongoing improvement.

• Meet departmental and company performance and attendance standards.

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

• Execute other duties as assigned.

• Travel approximately 5% of the time.

⛳️ Requirements

• At least three (3) years of clinical experience, including case management.

• 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 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.

• Knowledge and comprehension of contractual benefits as well as options outside of those benefits.

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

• Competence in using computerized systems for data recording and retrieval.

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

• Capability to establish and sustain relationships with community services and providers.

• Willingness to keep current clinical knowledge 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.

• Ability to stoop, bend, sit and/or stand for extended periods, perform repetitive motions, and lift and transport files and business materials.

• Experience in the insurance industry is preferred.

🏝️ Benefits

• Access to quality, affordable care through PacificSource membership.

• A work environment that emphasizes equal opportunity and diversity.

• Ergonomically designed equipment.

• At-will employment.