Apply on Employer Site

PacificSource Health Plans · 3 weeks ago

Care Management Clinician (Sunday – Thursday)

Boise, ID

Full-time

Onsite

Mid Level

3+ years exp

PacificSource Health Plans is dedicated to helping members access quality, affordable care. The Care Management Clinician is responsible for facilitating client wellness through advocacy, assessment, planning, and communication, while developing individualized care management plans and linking clients with appropriate healthcare resources.

CommunitiesCustomer ServiceNon Profit

Responsibilities

Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation

Collect and assess patient information pertinent to patient’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services

Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable

Clinicians have direct communication among, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines

Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients

Practice and model effective communication skills: both written and verbal

Utilize and promote use of evidence-based tools

Utilize lean methodologies for continuous improvement

Meet department and company performance and attendance expectations

Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

Perform other duties as assigned

Qualification

Clinical Social WorkerLicensed Professional CounselorLicensed Independent Clinical Social WorkerRegistered NurseCertified Case Manager CertificationCase management experienceHealth insurance knowledgeAdvocacyAssessmentPlanningResource managementCommunicationTeamworkProblem SolvingOrganizational skills

Required

Minimum of three (3) years of clinical experience, including case management

Clinical Social Worker, Licensed Professional Counselor, or Licensed Independent Clinical Social Worker with unrestricted license required in current state of residence

Registered Nurse with current appropriate unrestricted state license based on line of business: Commercial and Medicare: Oregon, Idaho or Montana, and Washington; Medicaid and DSNP: Oregon

CCM certification required within two years of hire

Knowledge of health insurance and state mandated benefits

Experience and expertise in case management practice including advocacy, assessment, planning, communication, education, resource management and service facilitation

Ability to deal effectively with people who have various health issues and concerns

Knowledge and understanding of contractual benefits and options available outside contractual benefits

Knowledge of community services, providers, vendors and facilities available to assist members

Ability to use computerized systems for data recording and retrieval

Assures patient confidentiality, privacy, and health records security

Establishes and maintains relationships with community services and providers

Maintains current clinical knowledge base and certification

Ability to work independently with minimal supervision