Offer summary

Qualifications:

Registered Nurse (RN) with a valid license in the state of operations., 3 years of clinical practice experience and 1 year in Health Insurance/Managed Care., Knowledge of clinical utilization management and case management activities., Strong verbal and written communication skills, along with PC proficiency. .

Key responsibilities:

Perform concurrent review and case management activities according to departmental guidelines.

Coordinate resources for treatment options to meet individual health needs.

Identify alternate treatment programs for chronic or catastrophic cases.

May serve as a preceptor for less experienced staff.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individual’s benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individual’s health needs; and may serve as a preceptor for less experienced staff.

JOB REQUIREMENTS:
Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.
3 years clinical practice experience.
1 year Health Insurance/Managed Care experience.
Knowledge of clinical utilization management/case management activities and standardized criteria set.
Knowledge of managed care and insurance industry.
Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
Verbal and written communication skills; analytical skills; sound clinical judgment.
PC proficiency to include Microsoft Word, Excel and Access.
Current driver’s license.
Ability and willingness to travel.
Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

PREFERRED JOB REQUIREMENTS:
Working toward CM certification or advanced degree.
Experience managing complex or catastrophic cases.
Experience in Disease Management.
Knowledge of Medical Management policies and procedures.
Familiarity with medical guidelines (M&R, Interqual, etc.).
Preparation of cost analysis on extra contractual benefit requests.

Telecommute:
This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

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Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.