Care Management Clinician

PacificSource Health Plans

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

Posted 9/15/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $70,950 - $106,425 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management practices, including advocacy, assessment, planning, and resource management, while ensuring compliance with ethical and regulatory standards. Proficient in maintaining patient confidentiality and utilizing evidence-based tools for effective care coordination.

Highest-signal resume keywords

Registered Nurse (RN) LicenseCertified Case Manager Certification (CCM)Case Management PracticeHealth Insurance KnowledgeCommunity Services Knowledge

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Case ManagementPatient AssessmentResource ManagementService FacilitationData RecordingEvidence-Based ToolsLean MethodologiesContractual Benefits KnowledgeHealthcare Resource ManagementClinical Experience

Soft Skills

Effective CommunicationRelationship BuildingIndependent WorkProblem SolvingAdvocacy

Certifications & Qualifications

Registered Nurse (RN) LicenseCertified Case Manager Certification (CCM)

Industry Keywords

Patient ConfidentialityHIPAA ComplianceHealth and Human ServicesCommunity ProvidersInsurance Industry Experience

About the role

Key responsibilities & impact

Facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation
Collect and assess patient information to develop comprehensive, individualized care management plans
Promote appropriate utilization and cost-effective care and services
Link clients with appropriate providers and resources across health and human services and care settings
Coordinate with clients, payers, primary care providers, and other service-delivery professionals
Maintain client privacy, confidentiality, health, and safety while adhering to ethical, legal, accreditation, certification, and regulatory standards
Answer medical or contract-interpretation questions referred by other departments, physicians, and providers
Assist employers and agents with healthcare-resource and procedure questions
Practice effective written and verbal communication
Utilize and promote evidence-based tools
Utilize lean methodologies for continuous improvement
Meet department and company performance and attendance expectations
Follow PacificSource privacy policy and HIPAA confidentiality and security requirements
Perform other duties as assigned
Travel approximately 5% of the time

Requirements

What you’ll need

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 required
Certified Case Manager Certification (CCM) accredited by CCMC required at hire or 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
Knowledge of contractual benefits and options outside contractual benefits
Knowledge of community services, providers, vendors, and facilities
Ability to use computerized systems for data recording and retrieval
Ability to maintain patient confidentiality, privacy, and health-record security
Ability to establish and maintain relationships with community services and providers
Ability to work independently with minimal supervision
Ability to read and comprehend written and spoken English
Ability to communicate clearly and effectively
Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and lift and carry files and business materials
Insurance industry experience preferred

Benefits

Comp & perks

Full-time employment
Work-from-home arrangement in Virginia
Equal opportunity and commitment to diversity, equity, inclusion, and social justice
Professional development through maintaining current clinical knowledge and certification
CCM certification may be obtained within two years of hire
At-will employment