Care Coordinator UM/CM II

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

Job summary

Join a purpose-driven company that values its employees and fosters professional growth. This remote position involves coordinating case management activities and collaborating with healthcare providers to enhance member benefits. With a focus on clinical utilization management, you'll play a crucial role in ensuring effective resource use and implementing treatment options tailored to individual health needs. The company offers a comprehensive benefits package, including health and wellness benefits, 401(k), and tuition reimbursement. If you're passionate about making a difference in healthcare, this opportunity is for you.

Benefits

Health and Wellness Benefits

401(k)

Pension

Paid Time Off

Parental Leave

Disability Insurance

Life Insurance

Employee Assistance

Paid Holidays

Tuition Reimbursement

Qualifications

• 3+ years of clinical practice and 1+ year in Health Insurance or Managed Care.
• Strong understanding of clinical utilization management and case management.

Responsibilities

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

Skills

Clinical Practice

Case Management

Communication Skills

Analytical Skills

PC Applications (Word, Excel, Access)

Education

Registered Nurse 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 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 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 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 willingness to travel.
• For incumbents with multi-state licenses, additional licenses may be required, which will be provided by HCSC.

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 (e.g., M&R, Interqual).
• Experience in preparing cost analyses for extra contractual benefit requests.

Additional Information

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, inquire about our 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, paid holidays, tuition reimbursement, and more. Details at https://careers.hcsc.com/totalrewards.

The offered salary depends 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 workplace. 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.

Compensation Range

$60,300.00 - $133,400.00