Primary Nurse Case Manager

1 week ago


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

**Job Summary**

Health Care Service Corporation (HCSC) is seeking a highly skilled and dedicated Primary Nurse Case Manager to join our team. As a Primary Nurse Case Manager, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.

**Key Responsibilities:**

  • Perform concurrent review, discharge planning, and care coordination for members with complex or catastrophic health conditions.
  • Identify alternate treatment programs and consult with physicians, providers, and other resources to evaluate options and services required to meet an individual's health needs.
  • Promote quality and cost-effective outcomes by coordinating care and services with healthcare providers and other stakeholders.
  • Serve as a liaison to physicians and members, providing education and support to ensure seamless care transitions.
  • Develop and implement individualized care plans that address the unique needs and goals of each member.
  • Collaborate with internal stakeholders, including case management teams, utilization management teams, and medical directors, to ensure that member needs are met and care is coordinated.
  • Stay up-to-date on the latest clinical guidelines, policies, and procedures to ensure that care is delivered in accordance with best practices.

**Requirements:**

  • Registered Nurse (RN) with current, valid, unrestricted license in the state of operations.
  • 2 years of clinical practice experience in 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 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 with 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.

**What We Offer:**

  • A competitive salary and benefits package.
  • Opportunities for professional growth and development.
  • A dynamic and supportive work environment.


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