Care Coordinator UM/CM II

Health Care Service Corporation; Oklahoma City (OK); Remote; USD 60,000 - 134,000; Full time

Job summary

Health Care Service Corporation is seeking a Registered Nurse for a remote case management role. This position involves performing concurrent reviews, discharge planning, and managing resources for patient treatment options. Candidates should have a valid RN license and relevant clinical experience. A comprehensive benefits package is offered, including health benefits, 401(k), and tuition reimbursement.

Benefits

Health and wellness benefits

401(k) and pension

Paid time off

Parental leave

Disability insurance

Tuition reimbursement

Employee assistance program

Paid holidays

Qualifications

• 3 years of clinical practice experience required.
• 1 year of health insurance/managed care experience preferred.
• Knowledge of clinical utilization management and case management activities.

Responsibilities

• Perform concurrent review and case management activities.
• Coordinate resources for treatment options that meet health needs.
• Discharge planning and identifying alternative treatment programs.

Skills

Clinical judgment

Analytical skills

Strong verbal communication

Strong written communication

Education

Registered Nurse (RN) 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 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. Responsibilities include discharge planning, identifying alternative treatment programs for chronic or catastrophic cases, and providing medically necessary, cost-effective services within the scope of the individual's benefit plan. The role involves applying Case Management principles to coordinate resources necessary for treatment options that meet the individual's health needs. The incumbent may also serve as a preceptor for less experienced staff.

Job Requirements:

1. Registered Nurse (RN) with current, valid, unrestricted license to practice in the state of operations.
2. At least 3 years of clinical practice experience.
3. One year of health insurance/managed care experience.
4. Knowledge of clinical utilization management/case management activities and standardized criteria sets.
5. Knowledge of managed care and the insurance industry.
6. Familiarity with ancillary services including HHC, SNF, Hospice, etc.
7. Strong verbal and written communication skills, analytical skills, and sound clinical judgment.
8. Proficiency in PC applications such as Microsoft Word, Excel, and Access.
9. Current driver's license and willingness to travel.
10. For positions requiring multi-state licenses, incumbents must obtain and maintain additional licenses as required. HCSC will cover multi-state license fees. Clinical licenses other than nursing do not require multi-state licensing.

Preferred Job Requirements:

1. Working toward Case Management certification or an advanced degree.
2. Experience managing complex or catastrophic cases.
3. Experience in Disease Management.
4. Knowledge of Medical Management policies and procedures.
5. Familiarity with medical guidelines (e.g., M&R, Interqual).
6. Experience in preparing cost analyses for extra contractual benefit requests.

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

Additional Information

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement: At Health Care Service Corporation, we offer a comprehensive benefits package including health and wellness benefits, 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. The role may be eligible for an annual incentive bonus, subject to plan terms and conditions.

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 any other protected characteristic.

Base Pay Range

$60,300.00 - $133,400.00