Care Coordinator, UM/CM I

Job not on LinkedIn

🔥 0 minutes ago

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $61.5k - $136.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Perform concurrent review in accordance with approved departmental guidelines • Perform discharge planning and identify alternate treatment programs • Conduct episodic case management • Consult and collaborate with providers, members, and other resources as appropriate • Assess, plan, and implement options and services required to meet individuals' health needs within the scope of their benefit plan

🎯 Requirements

• Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations • 3 years clinical practice experience • Experience utilizing various software packages • Verbal and written communication skills • Analytical skills • Nursing licenses in positions/departments requiring multi-state licenses must obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management • Familiarity with UM/CM activities and standardized criteria set • Familiarity with NFLOC (Nursing Facility Level of Care) for New Mexico Medicaid • Familiarity with LTSS (Long Term Support Services) for New Mexico Medicaid • Proficiency in MS Office Products: Word, Excel, PPT, Outlook, etc.

🏖️ Benefits

• Curated development plans and professional development • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan • Multi-state license fees provided by HCSC