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Care Coordination Specialist
2 months ago
At Health Care Service Corporation (HCSC), our workforce is the key to our achievements and the bedrock of our operations. We equip our team members with tailored development strategies that encourage advancement and cultivate rewarding, satisfying careers.
Become a part of HCSC and engage with a mission-driven organization that prioritizes your professional growth.
Job Overview
This role is accountable for executing initial and ongoing review processes; coordinating discharge care to assess the efficiency, effectiveness, and quality of medical and surgical services while acting as a conduit between healthcare providers and the medical and network management sectors. Responsibilities include gathering clinical and non-clinical information, confirming eligibility, and determining benefit levels according to contractual stipulations. Additionally, this position involves preparing reports on care quality, identifying and reporting cases, and providing guidance on utilization management standards and operational protocols to members, providers, and facilities.
Essential Qualifications:
• Active Registered Nurse (RN) license in the state of operation.
• Minimum of 3 years of clinical experience in a medical office, hospital/surgical environment, or health insurance organization.
• Proficient understanding of medical terminology and procedures.
• Strong verbal and written communication abilities.
• Willingness and capability to travel.
Preferred Qualifications:
• Experience in utilization management.
• MCG Certification.
Work Arrangement: This position is designed for remote work.
Additional Information: We are an Equal Opportunity Employment / Affirmative Action employer committed to fostering an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified candidates 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.
Compensation: Base Pay Range: $58,000 - $130,100.00
