Care Coordinator UM/CM II

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

Job summary

Join a purpose-driven company that empowers its employees to grow and develop rewarding careers. This remote position involves performing critical case management activities, working closely with healthcare providers and members to ensure optimal resource use and medical necessity evaluations. The role requires strong clinical judgment and communication skills, as well as a solid understanding of the health insurance industry. With a comprehensive benefits package and a commitment to professional development, this opportunity is perfect for those looking to make a meaningful impact in healthcare.

Benefits

Health and Wellness Benefits

401(k)

Pension

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Employee Assistance

Tuition Reimbursement

Qualifications

• 3+ years of clinical practice experience required.
• Knowledge of clinical utilization management and case management activities.

Responsibilities

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

Skills

Clinical Practice Experience

Health Insurance Knowledge

Analytical Skills

Communication Skills

PC Applications (Word, Excel, Access)

Education

Registered Nurse 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 departmental guidelines. The role involves collaboration with healthcare providers, members, and business partners to optimize member benefits, evaluate medical necessity, and promote effective resource use. Applying case management principles, the incumbent coordinates resources to implement treatment options that 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 of 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 such as HHC, SNF, Hospice, etc.
• Strong verbal and written communication skills, analytical skills, and sound clinical judgment.
• Proficiency in PC applications including 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 determined by management; fees will be provided by HCSC. Non-nursing 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 preparing cost analyses for extra contractual benefit requests.

Telecommute:

This is a remote role; candidates must reside within 250 miles of the office or anywhere within the posted state.

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Referral and Benefits:

If referred by a connection at HCSC, inquire about the Employee Referral process. We offer a comprehensive benefits package including health and wellness benefits, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance, holidays, tuition reimbursement, and more. Learn more at https://careers.hcsc.com/totalrewards.

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 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