Clinical Coordinator

3 days ago


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

This role is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance with contract guidelines. Prepares reports on quality of care, identifies and reports cases. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. Willingness and ability to travel.

Requirements
  • Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a physician office, hospital/surgical setting, or healthcare insurance company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.
  • Willingness and ability to travel.
Preferred Requirements
  • Utilization management experience.
  • MCG Certification.
  • Oncology experience.

This is a work-from-home role in New Mexico. You must live in or near Albuquerque, NM, for this position. Schedule is hybrid for the first six months, then transitioning to telecommute. Relocation assistance will not be provided for this position. Sponsorship will not be provided for this position.

HCSC is 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.



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