Care Management Clinician
Posted on: June 7, 2021
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PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
Diversity and Inclusion: PacificSource values the diversity of
the people we hire and serve. We are committed to creating a
diverse environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and
Case management is a collaborative process that assesses, plans,
implements, coordinates, monitors, and evaluates the options and
services required to meet the client's health and human service
needs. It is characterized by advocacy, communication, and resource
management and promotes quality and cost-effective interventions
Clinicians incorporate the essential functions of professional
case management concepts to enhance patients' quality of life and
maximize health plan benefits. These functions include, but are not
- Coordination and delivery of healthcare services
- Consideration of physical, psychological, and cultural
- Assessment of the patient's specific health plan benefits and
additional medical, community, or financial resources
- Clinician Care Managers facilitate the achievement of client
wellness and autonomy through advocacy, assessment, planning,
communication, education, resource management, and service
- 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
- 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
- Utilize and promote use of evidence-based tools. Utilize lean
methodologies for continuous improvement.
- Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
- Perform other duties as assigned.
Work Experience: Five years clinical experience, including case
management. Insurance industry experience preferred.
Education, Certificates, Licenses: Registered Nurse or Licensed
Clinical Social Worker or Licensed Professional Counselor with
current appropriate unrestricted state license. Certified Case
Manager Certification, or equivalent, strongly desired or
willingness to obtain certification within 2 years of hire.
Knowledge: 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.
Environment: Work inside in a general office setting with
ergonomically configured equipment. Travel is required
approximately 5% of the time.
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internally and externally.
- We actively work to advance social justice, equity, diversity
and inclusion in our workplace, the healthcare system and
- We encourage creativity, innovation, and the pursuit of
Physical Requirements: Stoop and bend. Sit and/or stand for
extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively.
Disclaimer: This job description indicates the general nature
and level of work performed by employees within this position and
is subject to change. It is not designed to contain or be
interpreted as a comprehensive list of all duties,
responsibilities, and qualifications required of employees assigned
to this position. Employment remains AT-WILL at all times.
Keywords: PacificSource, Bend , Care Management Clinician, Other , Bend, Oregon
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