Care Management Clinician

PacificSource Health Plans

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

Posted 11/3/2026full-timeRemote • Tennessee • United StatesMid-LevelSenior💰 $70,950 - $106,425 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management practices, including advocacy, assessment, planning, and resource management, while ensuring compliance with HIPAA laws and maintaining patient confidentiality. Proficient in developing individualized care management plans and effectively coordinating with clients, providers, and community resources.

Highest-signal resume keywords

Clinical ExperienceCertified Case Manager Certification (CCM)Registered Nurse (RN) LicenseCase Management PracticeKnowledge of Health Insurance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementPatient AssessmentCare Management PlansResource ManagementEvidence-Based ToolsData RecordingHealth Record SecurityCommunity Services KnowledgeContractual Benefits KnowledgeLean Methodologies

Soft Skills

Effective CommunicationRelationship BuildingCustomer ServiceAdvocacyIndependence

Certifications & Qualifications

Certified Case Manager Certification (CCM)Registered Nurse (RN) LicenseLicensed Professional Counselor (LPC)Licensed Marriage and Family Therapist (LMFT)Licensed Clinical Social Worker (LCSW)

Industry Keywords

Patient PrivacyHIPAA ComplianceHealth and Human ServicesService FacilitationCommunity ProvidersHealthcare ResourcesPerformance ExpectationsCost-Effective CareClinical Knowledge BaseHealth Issues

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 regarding history, condition, and functional abilities
Develop comprehensive, individualized care management plans promoting appropriate utilization and cost-effective care
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 professionals
Maintain client privacy, confidentiality, health, and safety through advocacy and adherence to applicable standards and guidelines
Answer medical or contract interpretation questions referred by other departments, physicians, and providers
Assist employers and agents with healthcare resource and procedure questions
Provide quality customer service to PacificSource personnel and members
Use and promote evidence-based tools
Utilize lean methodologies for continuous improvement
Meet performance and attendance expectations
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 time of hire or within two years of hire date
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 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 assure patient confidentiality, privacy, and health-record security
Ability to establish and maintain relationships with community services and providers
Ability to maintain current clinical knowledge base and certification
Ability to work independently with minimal supervision
Meet department and company performance and attendance expectations
Follow PacificSource privacy policy and HIPAA laws and regulations
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/carry files and business materials

Benefits

Comp & perks

Work from home arrangement indicated by location field (WFH: TN)
Equal opportunity employment
Continuous improvement and professional development through evidence-based tools and lean methodologies
At-will employment