Care Coordinator UM/CM II

Davita Inc.; Richardson (TX); Remote; USD 60,000 - 134,000; Full time

Job summary

A leading healthcare company is seeking a Registered Nurse for remote case management. Responsible for coordinating treatment options and managing resources, candidates need a valid RN license with clinical experience. The role offers competitive pay and benefits, fostering professional development in a supportive environment.

Benefits

Tuition reimbursement

401(k)

Paid time off

Parental leave

Paid holidays

Life insurance

Qualifications

• At least 3 years of clinical practice experience.
• 1+ year of Health Insurance/Managed Care experience.
• Knowledge of managed care and the insurance industry.

Responsibilities

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

Skills

Clinical utilization management

Analytical skills

Strong verbal communication

Strong written communication

Sound clinical judgment

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)

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 alternative 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 to coordinate 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 the state of operations.
• At least 3 years of clinical practice experience.
• 1+ year of Health Insurance/Managed Care experience.
• Knowledge of clinical utilization management/case management activities and standardized criteria set.
• Knowledge 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 ability and willingness to travel.
• Incumbents with nursing licenses requiring multi-state licensure must obtain and maintain additional licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Other clinical licenses do not require multi-state licenses.

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 preparing cost analysis for extra contractual benefit requests.

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

#LI-MG1

#LI-AK1

#LI-REMOTE

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 HCSC, we offer comprehensive benefits 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.

The offered compensation varies based on skills, education, and experience, and may include an annual incentive bonus, subject to plan terms.

HCSC Employment Statement: We are an Equal Opportunity Employer committed to a diverse and inclusive environment. All qualified applicants will be considered 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