Utilization Management Coordinator
1 week ago
At Health Care Service Corporation, 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.
We are a purpose-driven company that invests in our employees' professional development.
Job Summary
This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning and identifying alternate treatment programs; conducting episodic case management, consulting and collaborating with providers, members, and other resources as appropriate; assessing, planning, and implementing options and services required to meet an individual's health needs within the scope of their benefit plan.Key Responsibilities:
- Conduct concurrent reviews to ensure compliance with departmental guidelines.
- Develop and implement discharge plans to optimize patient outcomes.
- Identify and recommend alternative treatment programs to improve patient care.
- Collaborate with providers, members, and other stakeholders to ensure seamless care coordination.
- Assess and plan options and services to meet individual health needs.
Requirements:
- Registered Nurse (RN) with current, valid, unrestricted license to practice in the state of operations.
- 3 years of clinical practice experience.
- Experience utilizing various software packages.
- Verbal and written communication skills.
- Analytical skills.
Preferred Requirements:
- Familiarity with UM/CM activities and standardized criteria sets.
- Knowledge of ancillary services, including HHC, SNF, Hospice, etc.
HCSC Employment Statement:
We are an Equal Opportunity Employer/Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.
Base Pay Range:
$58,130.00-
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