Primary Nurse Case Manager

4 weeks ago

Albuquerque, New Mexico, United States Health Care Service Corporation Full time
Job Summary

This position is responsible for performing all NICU Specialty functions, as well as Utilization Management (UM), Case Management (CM), and Disease Management (DM). The Primary Nurse Coordinator serves as a single source of contact for members, healthcare personnel, and other entities involved in managing care.

Key Responsibilities
  • Perform concurrent review, discharge planning, and care coordination
  • Identify alternate treatment programs and consult with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs
  • Promote quality and cost-effective outcomes
  • Serve as liaison to physicians and members
  • Provide education and local resource information, and encourage member self-education
  • Function in a clinical care advisory role, assessing members for wellness education and disease management, introducing members to website tools, educating members regarding wellness and specific conditions, and facilitating the coordination of care for identified members
Requirements
  • Registered Nurse (RN) license with current, valid, and unrestricted license in the state of operations
  • 2 years of clinical practice experience with direct clinical care to the customer
  • 1 year of experience in Condition Management or Case Management in a health insurance, managed care, physician office, or hospital setting
  • PC proficiency, including 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 with ancillary services, including HHC, SNF, Hospice, etc.
Preferred Requirements
  • RN Compact License required
  • NICU Specialty required
  • NICU Certification
  • Experience in managing complex or catastrophic health cases
  • Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
  • 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
HCSC Employment Statement

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.

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.

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