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Nurse Case Manager

4 weeks ago

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

At Health Care Service Corporation, we empower our employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

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, healthcare personnel, and all other entities involved in managing care.

The Primary Nurse Case Admin I performs concurrent review, discharge planning, and care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.

Key Responsibilities:

  • Registered Nurse (RN) with current, valid, unrestricted license in the state of operations
  • 2 years of clinical practice experience of 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 of ancillary services including HHC, SNF, Hospice, etc
  • Verbal and written communication skills; analytical skills; sound clinical judgment

Preferred Qualifications:

  • 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

This position is a remote opportunity.

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.

Base Pay Range: $58,130.00