Care Management Clinician

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

📋 Description

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

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

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

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

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

• Uphold client privacy, confidentiality, health, and safety in line with ethical, legal, accreditation, certification, and regulatory standards.

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

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

• Implement evidence-based tools and lean methodologies to promote continuous improvement.

• Achieve department and company performance and attendance goals.

• Adhere to PacificSource privacy policies and HIPAA regulations.

• Perform additional duties as assigned.

• Work in a general office environment and travel approximately 5% of the time.

⛳️ Requirements

• A minimum of 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 is required at the time of hire or within two years of the hire date.

• Knowledge 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.

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

• Capacity to work independently with minimal supervision.

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

• Ability to communicate clearly and effectively.

• Insurance industry experience is preferred.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Opportunities for professional development and continuing education.

• Flexible work arrangements.