Care Coordinator UM / CM II

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

Job summary

A leading company in the healthcare sector is seeking a qualified Registered Nurse for a telecommute role focusing on case management and discharge planning. This position involves coordinating resources to provide cost-effective solutions, requiring a valid nursing license and clinical experience. The role supports professional development within an inclusive environment and offers competitive compensation and benefits.

Benefits

Comprehensive health and wellness benefits

401(k) and pension plans

Paid time off and parental leave

Tuition reimbursement

Qualifications

• Must hold a current, valid RN license to practice.
• Years of related clinical practice experience required.
• Experience in Health Insurance or Managed Care preferred.

Responsibilities

• Conduct concurrent review and case management activities.
• Implement treatment options to meet health needs.
• Serve as a preceptor for less experienced staff.

Skills

Verbal communication

Written communication

Analytical skills

Clinical judgment

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 in coordinating resources 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 employment.
• Years of clinical practice experience.
• 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.
• Verbal and written communication skills; analytical skills; sound clinical judgment.
• Proficiency in PC applications including Microsoft Word, Excel, and Access.
• Current driver’s license and willingness to travel.
• For positions/departments requiring multi-state licenses, incumbents must obtain and maintain additional licenses in other states as determined by management. Multi-state license fees will be provided by HCSC.
• For other clinical licenses, multi-state licenses are not required.

Preferred Job Requirements

• Working toward 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 (M&R, Interqual, etc.).
• Experience in cost analysis for extra contractual benefit requests.

Additional Information

This is a telecommute (remote) role: Must reside within 250 miles of the office or within the posted geographic area.

We encourage you to ask your connection at HCSC about our Employee Referral process if you are being referred to this role!

Benefits and Compensation

At HCSC, we offer a comprehensive benefits package including health and wellness benefits, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance programs, paid holidays, tuition reimbursement, and other incentives. The offered compensation will depend on your skills, education, and experience, and this role is eligible for an annual incentive bonus plan.

Equal Opportunity Employment

HCSC is an Equal Opportunity Employer committed to a diverse and inclusive workplace. 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.

Pay Range

$60,300.00 - $133,400.00