PacificSource
Utilization Management Clinician (Tuesday - Saturday)
Boise, ID
Sponsorship not specified$71k-$106kDetected 2 days ago
ComplianceCustomer SupportHIPAACommunicationCollaborationProblem SolvingAdaptabilityOrganizational Skills
About the role
- Looking for a way to make an impact and help people?
- Join PacificSource and help our members access quality, affordable care!
- PacificSource is an equal opportunity employer.
Responsibilities
- Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
- Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
- Work with multidisciplinary teams utilizing an integrated team-based approach to best support members, which may include working together on network not available (NNA), out of network exceptions (OONE), and one-time agreements (OTA).
- Perform other duties as assigned.
Requirements
- Ability to read and comprehend both written and spoken English.
- 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.
- Travel is required approximately 5% of the time.
- Insurance industry experience helpful, but not required.
Nice to have
- Case Manager Certification as accredited by CCMC preferred.
Skills
- Compensation Disclaimer
- Base Range:
- $70,950.00 - $106,424.99
- The wage range provided reflects the full range for this position.
- Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
Compensation
- The wage range provided reflects the full range for this position.
- The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage.
- Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
- Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.
Benefits
- Collaborate closely with physicians, nurses, social workers and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services.
- Assess the member's specific health plan benefits and the additional medical, community, or financial resources available.
- Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services.
- Minimum of three (3) years of nursing or behavioral health experience with varied medical and/or behavioral health exposure and capability required.
- Experience in acute care, case management, including cases that require rehabilitation, home health, behavioral health and hospice treatment strongly preferred.
- Thorough knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance and state-mandated benefits.
- Understanding of contractual benefits and options available outside contractual benefits.
Company info
- Accurately document case notes and letters of explanation which may become part of legal records.
Equal opportunity
- equal opportunity employer.
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