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Lead Nurse Case Administrator
2 months ago
At HCSC, we regard our workforce as the cornerstone of our operations and the foundation of our achievements.
We empower our employees to shape their careers through tailored development plans that guide their journey towards a rewarding and fulfilling profession.
Position Overview
This role is accountable for executing all aspects of Utilization Management (UM), Case Management (CM), and Disease Management (DM), serving as the primary contact for members, healthcare professionals, and all parties involved in care management.
The Lead Nurse Coordinator conducts concurrent reviews, discharge planning, and care coordination; identifies alternative treatment options; collaborates with physicians, providers, members, and other resources to assess needs and services required to address an individual's health requirements; advocates for quality and cost-effective outcomes; and acts as a liaison between physicians and members.
Additional responsibilities include episodic case management, determining member treatment assignments, and providing pre-admission/post-discharge counseling for acute conditions.
Establish rapport with members during the immediate post-discharge follow-up period or until all short-term care needs are addressed.
Deliver education/local resource information and promote member self-education.
In a clinical advisory capacity, the Lead Nurse Coordinator evaluates members for wellness education and disease management, introduces members to our online tools, educates them about wellness and specific health conditions, and facilitates care coordination for identified members.
Qualifications:
- Registered Nurse (RN) with a current, valid, unrestricted license in the state of operations
- 2 years of clinical practice experience providing direct care to patients
- 1 year of experience in Condition Management or Case Management within a health insurance, managed care, physician office, or hospital environment.
- Proficiency in PC applications including Word, Excel, Lotus Notes, and database management
- Clear and effective verbal and written communication skills
- Understanding of UM/CM/DM activities and standardized criteria
- Familiarity with ancillary services such as Home Health Care (HHC), Skilled Nursing Facilities (SNF), Hospice, etc.
- Strong analytical skills and sound clinical judgment
- Candidates with nursing licenses in positions requiring multi-state licenses must obtain and maintain additional current, valid, and unrestricted nursing licenses in other states as required by management. Multi-state license fees will be covered by HCSC.
PREFERRED QUALIFICATIONS:
- Experience in managing complex or catastrophic health cases
- Specialty clinical experience in intensive care, orthopedics, NICU/pediatrics, oncology, diabetes management, obstetrics (low to high-risk maternity management)
- Progress towards or completion of CCM/CCP/CDE certification or an advanced degree
- Familiarity with Milliman Guidelines or similar clinical guidelines
- Knowledge of medical management policies and procedures
This position operates Monday through Friday with occasional weekend obligations.
Remote work opportunity available.
Must possess an IL RN license.
HCSC Employment Statement:
HCSC is dedicated to fostering diversity in the workplace and providing equal opportunity and affirmative action to all employees and applicants.
We are an Equal Opportunity Employment / Affirmative Action employer committed to workforce diversity and maintaining a drug-free and smoke-free environment.
Background checks and drug screenings are required, as permitted by law.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
