Care Coordinator UM/CM II

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

Job summary

Health Care Service Corporation seeks a Registered Nurse for a remote case management position. The role involves clinical review, treatment planning, and resource coordination for chronic and catastrophic cases, requiring a valid RN license and 3 years of clinical experience. Join a company that values employee development and inclusivity.

Qualifications

• 3 years clinical practice experience required.
• Health Insurance/Managed Care experience preferred.
• Experience managing complex cases is a plus.

Responsibilities

• Perform concurrent review and case management activities.
• Discharge planning and identifying alternate treatment programs.
• Coordinate resources necessary to implement treatment options.

Skills

Verbal Communication

Analytical Skills

Clinical Judgment

PC Proficiency

Education

Registered Nurse License

CM Certification (in progress)

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 to 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.

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; applying Case Management principles in coordinating 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 state of operations.
• 3 years clinical practice experience.
• year Health Insurance/Managed Care experience.
• Knowledge of clinical utilization management/case management activities and standardized criteria set.
• Knowledge of managed care and insurance industry.
• Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
• Verbal and written communication skills; analytical skills; sound clinical judgment.
• PC proficiency to include Microsoft Word, Excel and Access.
• Current driver’s license.
• Ability and willingness to travel.
• Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

PREFERRED JOB REQUIREMENTS:

• Working toward CM certification or 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.).
• Preparation of cost analysis on extra contractual benefit requests.

This is a Telecommute (Remote) role: Must reside withing 250 miles of the office or anywhere within the posted state.

Compensation: $60,300.00 - $133,400.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards