Care Coordinator UM/CM II

Health Care Service Corporation; Town of Texas, Richardson (WI, TX); 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 be responsible for performing case management activities, optimizing member benefits, and collaborating with healthcare providers. This position offers a rewarding opportunity to make a significant impact on individuals' health needs while enjoying comprehensive benefits and a supportive work environment. If you are a dedicated Registered Nurse with a passion for case management, this is the perfect opportunity for you to advance your career.

Benefits

Health Insurance

401(k)

Pension

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Employee Assistance Program

Tuition Reimbursement

Holidays

Qualifications

• Must have a current RN license and at least 3 years of clinical experience.
• Knowledge of case management and clinical utilization management is essential.

Responsibilities

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

Skills

Registered Nurse (RN)

Clinical Practice Experience

Health Insurance Knowledge

Analytical Skills

Communication Skills

Clinical Judgment

Proficiency in Microsoft Word, Excel, Access

Education

Registered Nurse License

Advanced Degree (Preferred)

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 approved departmental guidelines. It involves collaboration with healthcare providers, members, and business partners to optimize member benefits through evaluation of medical necessity and promoting effective resource use. The role applies case management principles to coordinate resources necessary for implementing 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 1 year of experience in health insurance or managed care.
• Knowledge of clinical utilization management and case management activities, including 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 in other states as determined by management; fees are covered by HCSC.

Preferred Job Requirements:

• Working toward certification in case management 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:

If referred by a connection at HCSC, inquire about our Employee Referral process.

Pay transparency: We offer comprehensive benefits including health, wellness, 401(k), pension, paid time off, parental leave, disability, life insurance, employee assistance, holidays, tuition reimbursement, and more. Details at https://careers.hcsc.com/totalrewards.

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

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