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 thorough, personalized care management plans.

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

• Connect clients to suitable providers and resources in health and human services as well as care settings.

• Ensure that care is safe, effective, client-centered, 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 adherence to relevant standards and guidelines.

• Deliver quality customer service and serve as an internal resource for inquiries regarding medical or contract interpretations.

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

• Employ and advocate for evidence-based tools.

• Apply lean methodologies for ongoing improvement.

• Meet departmental and company performance and attendance standards.

• Adhere to PacificSource privacy policy 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.

• Certification as a Certified Case Manager (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.

• Capability to effectively interact with individuals experiencing various health issues and concerns.

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

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

• Proficiency in using computerized systems for data recording 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 keeping current with clinical knowledge and certification.

• Ability to work independently with minimal supervision.

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

• Ability to communicate in a clear and effective manner.

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

• Capacity for repetitive motions including typing, sorting, and filing.

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

🏝️ Benefits

• Equal opportunity employment.

• Travel is approximately 5% of the time.