Teams at PacificSource Health Plans

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, behavioral health, and outpatient services for medical necessity and appropriate utilization; coordinates discharge planning, referrals, vendors, providers, and community resources; supports members and families navigating healthcare systems; documents clinical and authorization decisions; collaborates with multidisciplinary teams and Medical Directors; and ensures compliance with health plan benefits, evidence-based criteria, HIPAA, and applicable regulations.

Provides utilization management and care coordination for health plan members. Reviews inpatient and behavioral health admissions, preauthorizations, continued stays, and discharge plans using evidence-based criteria. Coordinates medical, behavioral, community, and financial resources; supports members and families; negotiates with providers and vendors; documents clinical decisions; identifies high-cost cases; and advises internal teams on medical and benefit questions. Requires a licensed clinical professional with healthcare experience.

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, partial hospitalization, referral, and preauthorization cases; evaluates medical necessity and continued-stay appropriateness; coordinates discharge planning and community resources; negotiates with vendors and providers; supports members, families, employers, and internal teams; documents case information; and assists with healthcare guidelines, cost-effective care strategies, and quality outcomes.