Jobs in the United States

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Added just now
Bakery Clerk
Albertsons Companies
TUCSON, AZ · Tucson, AZ
…tasks from start to finish. Working alongside the Bakery Sales Manager, the Baker’s Helper helps plan the day’s production, gathers ingredients, and follows recipes with accuracy and…
Added just now
00089100-316-14166-All Purpose Clerk-1002LC-WP
Albertsons Companies
LAS VEGAS, NV · Las Vegas, NV
…tasks from start to finish. Working alongside the Bakery Sales Manager, the Baker’s Helper helps plan the day’s production, gathers ingredients, and follows recipes with accuracy and…
Added just now
Plant Supervisor
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DENVER, CO · Denver, CO
Are you ready to take the next step in your career? Join us for an exciting opportunity at Albertsons Companies, where innovation and customer service go hand-in-hand!
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Construction Project Manager (Heavy Civil/Bridge)
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Bilingual (Spanish) Financial Service Representative
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…promoting from within. Today, I am proud to serve as a District Manager, a position I moved into in 2021 – Also, a testament to the growth opportunities the company provides. The company…
Added 1 min ago
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General Manager
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- $24 USD / hour
As a General Manager (GM), you’ll provide reliable financial solutions to help customers manage everyday challenges. As the driving force behind the store’s success, you’ll manage daily…
Added 1 min ago
Channel Manager - Commercial Building Services
Grundfos
Atlanta, GA · Brookshire, TX · Chicago, IL · Houston, TX · Orlando, FL · Philadelphia, PA
As our new Channel Manager, Commercial Business, you'll be translating business strategy, portfolio direction, and digital capabilities into effective execution across distributors and…
Added 1 min ago
Marketing Manager, US Foot & Ankle
MEDICAL DEVICE BUSINESS SERVICES, INC. Legal Entity
West Chester, PA
DePuy Synthes is currently recruiting for a Marketing Manager, Foot & Ankle to be located in West Chester, PA.
Added 1 min ago
Regional Sales Manager, Spine
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Candidates must possess a valid driver's license issued in the United States
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Manager, Worldwide Education (Remote, US) Johnson and Johnson MedTech, Electrophysiology
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…education strategy. The educational needs of both customers and customer facing employees are in scope and must be approached with a global mindset. The Manager, Global Education will…
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Area Sales Manager
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Remote, United States
…presence within an assigned sales territory. The Area Sales Manager will focus on selling capital equipment and software solutions, developing strong customer relationships, and identifying…
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Delivery Driver-CDL B
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- $21 USD / hour
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Dietary Director
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POSITION PURPOSE: To provide an efficient, exceptional dining experience with first-class customer service. In keeping with our organization’s goal of improving the lives of the residents…
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Account Executive, Sr - San Antonio
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Closely works with SVP and Regional Sales Manager on various initiatives that promote growth and development of the DBU Field Sales Team.
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PacificSource

Utilization Management Clinician - PART TIME

Springfield, OR, United States

$70,950.00 - $106,424.99 Our Values We live and breathe our values. · Part-time

Apply on pacificsource.wd5.myworkdayjobs.com About employer

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Job details

Pay: $70,950.00 - $106,424.99 Our Values We live and breathe our values.
Job type: Part-time
Posting language: English
Posted: Nov 11, 2026

Original job description

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. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

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. Facilitate outstanding member care using fiscally responsible strategies.

Essential Responsibilities:

Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services.
Coordinate necessary resources to achieve member outcome goals and objectives.
Accurately document case notes and letters of explanation which may become part of legal records.
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.
Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions.
Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.
When applicable, identify and negotiate with appropriate vendors to provide services.
When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development.
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).
Serve as primary resource to member and family members for questions and concerns related to the health plan and in navigating through the health systems issues.
Interact with other PacificSource personnel to assure 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.
Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate.
Assist Medical Director in developing guidelines and procedures for Health Services Department.

Supporting Responsibilities:

Act as backup and be a resource for other Health Services Department staff and functions as needed.
Serve on designated committees, teams, and task groups, as directed.
Represent the Heath Services Department, both internally and externally, as requested by Medical Director.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: 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. Insurance industry experience helpful, but not required.

Education, Certificates, Licenses: Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner, (PMHNP) credential required. Case Manager Certification as accredited by CCMC preferred.

Knowledge: 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. Working knowledge of community services, providers, vendors and facilities available to assist members. Understanding of 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 community.

Competencies:

Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer 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.

Base Range:

$70,950.00 - $106,424.99 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. 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. Employment remains AT-WILL at all times.

Apply on pacificsource.wd5.myworkdayjobs.com About employer

More about this job

Skills

Customer service
Acute care
Case management
RN
Mental health
NP
CPT
Work independently
Adaptability
Process improvement
Collaboration
Communication skills
Organizational skills
Problem solving
Teamwork

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Work requirements

Jobs in the United States