Primary Nurse Case Manager

3 days ago


Richardson, Texas, United States Health Care Service Corporation Full time
Job Summary

This position is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all 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 and serve as liaison to physicians and members
  • Provide education and local resource information and encourage member self-education
  • Assess members for wellness education and disease management and introduce members to our website tools
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 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
Work Environment

This is a work from home position in Houston, TX. You must live in or near Houston, TX for this role. Will visit members in Houston based hospitals. This is 100% case management.

HCSC is an Equal Opportunity Employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.



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