Care Coordinator UM/CM II

Health Care Service Corporation; Albuquerque (NM); Remote; USD 60,000 - 134,000; Full time

Job summary

Join a purpose-driven company that values employee growth and development. This remote position focuses on case management and discharge planning, requiring a Registered Nurse with extensive clinical experience. You will collaborate with healthcare providers and members to optimize benefits and ensure effective resource use. Enjoy comprehensive benefits, including health, wellness, and retirement plans, while making a meaningful impact in the healthcare field. This role offers the chance to grow your career in a supportive environment that prioritizes professional development.

Benefits

Health and Wellness Benefits

401(k) Plan

Pension

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Employee Assistance Program

Tuition Reimbursement

Paid Holidays

Qualifications

• RN with a valid license and 3+ years of clinical practice.
• Experience in Health Insurance/Managed Care and case management.

Responsibilities

• Perform concurrent review and case management activities.
• Collaborate with healthcare providers and business partners.

Skills

Clinical Practice Experience

Health Insurance/Managed Care

Clinical Utilization Management

Communication Skills

Analytical Skills

Microsoft Word

Microsoft Excel

Microsoft Access

Sound Clinical Judgment

Education

Registered Nurse License

CM Certification (preferred)

Advanced Degree (preferred)

Tools

PC Applications

Job description

At HCSC, our employees are the cornerstone of our business and the foundation of our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that invests in your professional development.

Job Summary

This position is responsible for performing concurrent review and case management activities in discharge planning in accordance with approved departmental guidelines. It involves collaboration with healthcare providers, members, and business partners to optimize member benefits, evaluate medical necessity, and promote effective resource use. The role applies Case Management principles to coordinate resources necessary for implementing treatment options that meet the individual's health needs.

Job Requirements:

• Registered Nurse (RN) with current, valid, unrestricted license to practice in the state of operations.
• At least 3 years of clinical practice experience.
• Minimum 1 year of experience in Health Insurance/Managed Care.
• Knowledge of clinical utilization management/case management activities and standardized criteria sets.
• Understanding of managed care and the insurance industry.
• Familiarity with ancillary services including HHC, SNF, Hospice, etc.
• Strong verbal and written communication skills, analytical skills, and sound clinical judgment.
• Proficiency in PC applications such as Microsoft Word, Excel, and Access.
• Current driver's license and willingness to travel.
• Incumbents with nursing licenses in multi-state positions must obtain and maintain additional licenses as required by management. HCSC covers multi-state license fees. Other clinical licenses do not require additional licenses.

Preferred Job Requirements:

• Working towards CM certification or an advanced degree.
• Experience managing complex or catastrophic cases.
• Experience in Disease Management.
• Knowledge of Medical Management policies and procedures.
• Familiarity with medical guidelines (e.g., M&R, Interqual).
• Experience in preparing cost analyses for extra contractual benefit requests.

Telecommute:

This is a remote role: candidates must reside within 250 miles of the office or anywhere within the posted state.

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Referral & Benefits:

If referred by a connection at HCSC, inquire about our Employee Referral process. We offer comprehensive benefits including health and wellness, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance, paid holidays, tuition reimbursement, and more. Learn more at https://careers.hcsc.com/totalrewards.

Compensation varies based on skills, education, and experience, and may include an annual incentive bonus plan, subject to plan terms.

HCSC Employment Statement:

We are an Equal Opportunity Employer committed to a diverse and inclusive environment. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Base Pay Range

$60,300.00 - $133,400.00