PacificSource Health Plans

Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions and conduct appropriate research for prompt resolution of disputed claims.

The FWA Program Manager is primarily responsible for designing, implementing, and managing the company’s FWA Program, providing expertise for tracking, investigating, and managing suspected FWA complaints. This role involves building the program structure with policies and procedures, chairing the Program Integrity Committee, and ensuring compliance with state and federal FWA requirements.

This role leads the strategic design, implementation, and execution of Payment Integrity programs to improve payment accuracy and member affordability, serving as a key liaison for reimbursement policy and PI initiatives. Essential duties include overseeing pre- and post-payment programs, managing external vendors, directing FWA detection efforts, and ensuring compliance with coding and regulatory guidelines.

Clinician Care Managers facilitate client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation to develop comprehensive, individualized care management plans. They link clients with appropriate resources across the care continuum while ensuring care is safe, effective, timely, and equitable, maintaining direct communication among all service providers.

This role is accountable for the effective management of Clinical Care Managers, including hiring, training, coaching, counseling, and performance evaluation. The Clinician Team Lead actively participates in program development and implementation while supervising staff regarding company policies and procedures.

The Manager of Payment Integrity (PI) leads the strategic design, implementation, and execution of programs aimed at improving payment accuracy and enhancing member affordability. This role serves as a key liaison for reimbursement policy and PI initiatives, ensuring alignment be...

The Senior Clinical Pharmacy Strategist is responsible for improving, developing, and implementing initiatives to execute clinical pharmacy strategies and management priorities, supporting the Vice President of Pharmacy Services in executing enterprise cost of care strategies and quality initiatives impacting STARS rating and HEDIS measures. Key duties involve cross-departmental collaboration to analyze, design, and implement infrastructures for programs that optimize medication use and support CMS STAR ratings and PQA performance measures.

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,...

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,...

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,...