Primary Nurse Case Admin 1

🔥 1 minute ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $61.5k - $136.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.

📋 Description

• Performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM). • Serving as the single source of contact for members, health care personnel and all other entities involved in managing care. • Performing concurrent review, discharge planning and care coordination. • Identifying alternate treatment programs and consulting with physicians, providers, members, and other resources. • Promoting quality and cost-effective outcomes. • Serving as liaison to physicians and members. • Establishing relationships with members through the immediate post-discharge follow-up period or until all short-term care needs are met. • Providing education/local resource information and encouraging member (self) education. • Functioning in a clinical care advisory role assessing members for wellness education and disease management.

🎯 Requirements

• Registered Nurse (RN) with current, valid, unrestricted license in state of operations • 2 years clinical practice experience of direct clinical care to the customer • 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting. • PC proficiency to include Word, Excel, Lotus Notes and database experience • Clear and concise verbal and written communication skills • Knowledge of UM/CM/DM activities and standardized criteria set • Familiarity of ancillary services including HHC, SNF, Hospice, etc • Verbal and written communication skills; analytical skills; sound clinical judgment • Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

🏖️ Benefits

• Health insurance • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement