Care Coordinator UM/CM II

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

Job summary

Health Care Service Corporation is seeking a Registered Nurse to perform case management and discharge planning. This remote role requires clinical expertise and experience in managed care, offering a comprehensive benefits package and competitive salary based on skills and experience.

Benefits

401(k)

Pension

Paid time off

Parental leave

Disability insurance

Tuition reimbursement

Qualifications

• At least 3 years of clinical practice experience.
• One year of health insurance/managed care experience.
• Knowledge of clinical utilization management and case management activities.

Responsibilities

• Perform concurrent review and case management activities.
• Coordinate resources for treatment options to meet health needs.
• Discharge planning and identifying alternate treatment programs.

Skills

Clinical judgment

Analytical skills

Communication

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

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 will invest in your professional development.

Job Summary

This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary, cost-effective services within the scope of the individual's benefit plan. The role involves applying Case Management principles to coordinate resources necessary to implement treatment options to meet the individual's health needs and may serve as a preceptor for less experienced staff.

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.
• One year of health insurance/managed care experience.
• Knowledge of clinical utilization management/case management activities and standardized criteria sets.
• Knowledge 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 including Microsoft Word, Excel, and Access.
• Current driver's license and willingness to travel.
• For positions requiring multi-state licenses, incumbents must obtain and maintain additional licenses as determined by management. HCSC will cover the fees. Other clinical licenses do not require multi-state licensing.

Preferred Job Requirements:

• Working toward Case Management 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 such as M&R, Interqual, etc.
• Experience preparing cost analyses for extra contractual benefit requests.

This is a telecommute (remote) role: Candidates must reside within 250 miles of the office or anywhere within the posted state.

Referral Process: If you are being referred to this role, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement

At Health Care Service Corporation, we offer a comprehensive benefits package, including health and wellness benefits, 401(k), pension, paid time off, parental leave, disability insurance, supplemental life insurance, employee assistance programs, paid holidays, tuition reimbursement, and other incentives. Learn more at https://careers.hcsc.com/totalrewards.

The offered compensation varies based on skills, education, and experience and is aligned with an annual incentive bonus plan, subject to plan terms and conditions.

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