Care Management Clinician

Quantum Recruiters is partnering with a leading organization in the Pacific Northwest, and is hiring a Care Management Clinician. 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 and outcomes. 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 limited to : Coordination and delivery of healthcare services, Consideration of physical, psychological, and cultural factor,s Assessment of the patient’s specific health plan benefits and additional medical, community, or financial resources available

Essential 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 the 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 personnel to ensure 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 the use of evidence-based tools.
• Utilize lean methodologies for continuous improvement.

Supporting Responsibilities :

SUCCESS PROFILE

Work Experience :

Minimum of three (3) years of clinical experience, including case management. Insurance industry experience preferred.

Education, Certificates, Licenses :

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

Registered Nurse with current, appropriate, unrestricted state license based on line of business as listed below :

Commercial and Medicare : Oregon, Idaho or Montana, and Washington

Medicaid and DSNP : Oregon

Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) is strongly desired at the time 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.