PacificSource is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with an 82-year history and reputation for service excellence. At PacificSource it is our 900+ employees that make a difference. We have offices in multiple States and communities including: Bend, OR, Springfield, OR, Tigard, OR, Medford, OR, Boise, ID, and Helena, MT to name a few. We invest in the communities we serve by partnering with local providers to deliver high quality, accessible healthcare, and through charitable giving and personal involvement with non-profit organizations. Join us in our mission of helping people get the healthcare they need and let your work make a difference, too. We offer excellent benefits, competitive wages, and opportunities for growth and promotion.
Coordinate all aspects of the care of individual members. Ensure proper utilization of services and resources. Review of prior authorization requests for appropriateness of care within established evidence base criteria sets. Provide assistance within, between, and outside of facilities. Facilitate outstanding member care using fiscally responsible strategies. 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.
Work Experience: Five years of nursing experience with varied medical exposure and experience preferred. Experience in acute care, case management, including cases that require rehabilitation, home health, and hospice treatment strongly preferred. Insurance industry experience helpful, but not required. Education, Certificates, Licenses: Registered Nurse with current unrestricted state license. [Oregon license required at time of hire; Montana and Idaho required within 6 months of hire.) Certified Case Manager (CCM) as accredited by CCMC (The Commission for Case Management Certification) preferred. Knowledge: Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedures codes including ICD 10 and CPT Codes, health insurance and state-mandated benefits. Understanding of contractual benefits and options available outside contractual benefits. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of, and ability to create appropriate case management plans. 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. Must be able to function as part of a collaborative, cohesive team.
PacificSource is anything but a typical health plan. We’re a growing, independent, not-for-profit organization founded in 1933, and a reputation for service excellence. At PacificSource it is our 700+ employees that make a difference. We invest in the communities we serve by partnering with local providers to deliver high quality, accessible healthcare, and through charitable giving and personal i...nvolvement with non-profit organizations. Join us in our mission of helping people get the healthcare they need and let your work make a difference, too.
Company Benefits: PacificSource provides an excellent benefit package to ensure the well being of employees and their families. Benefits include medical, dental, prescription and vision insurance paid 100% by the employer for the employee. Other employer paid benefits include a bonus incentive program, 401k plan, generous paid time off, paid sick time and holidays, life insurance, long-term disability and tuition reimbursement. Many voluntary programs are also offered, including flexible spending accounts.