Care Coordinator UM/CM II

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

Job summary

Join a purpose-driven company that values employee development. This remote role involves case management activities, optimizing member benefits through collaboration with healthcare providers. As a Registered Nurse, you'll apply your clinical expertise in a supportive environment that fosters growth. Enjoy meaningful benefits such as health and wellness programs, 401(k), and tuition reimbursement. This is an exciting opportunity to make a positive impact in the healthcare industry while advancing your career in a dynamic organization.

Benefits

Health and Wellness Benefits

401(k) Plan

Pension Plan

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Employee Assistance Program

Tuition Reimbursement

Holiday Pay

Qualifications

• 3+ years of clinical practice experience required.
• Knowledge of clinical utilization management and case management.

Responsibilities

• Perform concurrent review and case management activities.
• Collaborate with healthcare providers to optimize member benefits.

Skills

Clinical Practice Experience

Health Insurance Knowledge

Analytical Skills

Communication Skills

Case Management Principles

Education

Registered Nurse (RN) License

Advanced Degree or Certification

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 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. The role involves collaboration with healthcare providers, members, and business partners to optimize member benefits through evaluation of medical necessity and promoting effective resource utilization. Applying case management principles, the incumbent coordinates resources necessary to implement treatment options that meet the individual's health needs.

Job Requirements

• Registered Nurse (RN) with a current, valid, unrestricted license to practice in the state of operations.
• At least 3 years of clinical practice experience.
• Minimum of 1 year of experience in health insurance or 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 positions requiring multi-state licensure must obtain and maintain additional licenses as determined by management; fees will be provided by HCSC. Other clinical licenses do not require multi-state licensure.

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 in preparing cost analyses for extra contractual benefit requests.

Telecommute Details

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

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Referral and Benefits

Ask your connection at HCSC about our Employee Referral process if you are being referred to this role.

Pay Transparency: We offer meaningful benefits including health and wellness, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance, holidays, tuition reimbursement, and other incentives. Learn more at https://careers.hcsc.com/totalrewards.

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

Equal Opportunity Employment Statement

We are committed to a welcoming environment that respects and values diversity. All qualified applicants will receive consideration without regard to 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