Clinical Care Coordinator
4 weeks ago
At Health Care Service Corporation, we empower our employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
This position is responsible for performing all functions of Utilization Management (UM), Case Management (CM), and Disease Management (DM). The Primary Nurse Coordinator performs concurrent review, discharge planning, and care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.
Key Responsibilities:
- Concurrent review and discharge planning
- Care coordination and identification of alternate treatment programs
- Consultation with physicians, providers, members, and other resources
- Promotion of quality and cost-effective outcomes
- Liaison to physicians and members
Requirements:
- Registered Nurse (RN) with current, valid, unrestricted license in state of operations
- 2 years clinical practice experience of direct clinical care to the customer
- 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office, or hospital setting
- PC proficiency to include Word, Excel, Lotus Notes, and database experience
- Clear and concise verbal and written communication skills
- Knowledge of UM/CM/DM activities and standardized criteria set
- Familiarity of ancillary services including HHC, SNF, Hospice, etc
Preferred Requirements:
- Experience in managing complex or catastrophic health cases
- Specialty clinical experience in NICU/pediatric, and obstetric (low to high risk maternity management) strongly desired
- Working toward or completion of CCM/CCP/CDE certification or Advanced degree
- Knowledge of Milliman Guidelines or similar clinical guidelines
- Knowledge of medical management policies and procedures
Work Environment:
This position is 100% UM/Telecommute in Texas. Possible weekend coverage (1 day).
We are an Equal Opportunity Employment/Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.
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