Care Coordinator UM/CM II

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

Job summary

Join a purpose-driven company that values employee growth and development. In this remote role, you will coordinate case management activities and collaborate with healthcare providers to optimize member benefits. This position requires a Registered Nurse with clinical experience and knowledge of managed care. Enjoy comprehensive benefits including health and wellness programs, 401(k), and tuition reimbursement. If you are passionate about making a difference in healthcare, this is the role for you!

Benefits

401(k)

Pension Plan

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Tuition Reimbursement

Employee Assistance Program

Paid Holidays

Health and Wellness Benefits

Qualifications

• Registered Nurse with a valid license to practice in the state.
• 3+ years of clinical practice and 1+ year in health insurance.

Responsibilities

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

Skills

Clinical Practice Experience

Health Insurance Knowledge

Case Management Principles

Communication Skills

Analytical Skills

Microsoft Office Suite

Education

Registered Nurse License

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 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 use. Applying case management principles, the incumbent coordinates resources to implement treatment options that meet individuals' 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 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 with 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 required by management. HCSC will cover multi-state license 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 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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Referral and Benefits:

Ask your HCSC connection about our employee referral process if referred. 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. Details at https://careers.hcsc.com/totalrewards.

Compensation varies based on skills, education, and experience, and is aligned with an annual incentive bonus plan.

Employment Statement:

HCSC is an Equal Opportunity Employer committed to a welcoming environment that respects diversity. 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