Care Coordinator UM/CM II

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

Job summary

An established industry player is seeking a dedicated Registered Nurse to join their remote team. This role focuses on performing concurrent reviews and case management activities, ensuring optimal resource use for members' health needs. You will collaborate with healthcare providers and utilize your clinical expertise to implement effective treatment options. The organization values professional development and offers comprehensive benefits, making it an excellent opportunity for those passionate about healthcare and patient advocacy. If you are ready to make a meaningful impact, this position is for you.

Benefits

Health and Wellness Plans

401(k)

Pension

Paid Time Off

Parental Leave

Disability Insurance

Tuition Reimbursement

Employee Assistance Program

Paid Holidays

Qualifications

• 3+ years of clinical practice experience required.
• Experience in Health Insurance/Managed Care is essential.

Responsibilities

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

Skills

Clinical Practice Experience

Health Insurance/Managed Care Experience

Clinical Utilization Management

Strong Verbal and Written Communication Skills

Analytical Skills

Sound Clinical Judgment

Education

Registered Nurse (RN) License

Case Management Certification (Preferred)

Advanced Degree (Preferred)

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. It involves collaboration with healthcare providers, members, and business partners to optimize member benefits through evaluation of medical necessity and promoting effective use of resources. The role applies Case Management principles to coordinate resources necessary to implement treatment options to 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 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 requiring multi-state licensing must obtain and maintain additional licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Those with other clinical licenses are not required to obtain multi-state licenses.

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 (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 within the posted state.

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Additional Information:

If referred, inquire about our Employee Referral process. We offer comprehensive benefits including health and wellness plans, 401(k), pension, paid time off, parental leave, disability insurance, supplemental life insurance, employee assistance program, paid 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.

HCSC Employment Statement:

We are an Equal Opportunity Employer committed to a diverse and inclusive environment. 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