Care Coordinator UM/CM II

Job ID: DE-1019542 Description:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

BASIC FUNCTION:

This position is responsible for performing concurrent review in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for cases including complex, chronic or catastrophic cases, while providing medically necessary cost effective services within the scope of the individuals benefit plan; coordinating resources necessary to implement treatment options to meet the individuals health needs; and contact list of providers to manage out of network requests by providing alternative in network options. May serve as a preceptor for less experienced staff.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with current, valid, unrestricted clinical license to practice in state of operations.
  • 3 years clinical practice experience.
  • 1 year Health Insurance/Managed Care experience.
  • Knowledge of clinical utilization management/case management activities and standardized criteria set.
  • Knowledge of managed care and insurance industry.
  • Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
  • Verbal and written communication skills; analytical skills; sound clinical judgment.
  • PC proficiency to include Microsoft Word, Excel and Access.
  • 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.

PREFERRED JOB REQUIREMENTS:

  • Working toward CM or CCP certification or advanced degree.
  • Experience managing complex, chronic or catastrophic cases.
  • Experience in Disease Management.
  • Knowledge of Medical Management policies and procedures.
  • Familiarity with medical guidelines (M&R, Interqual, etc.).
  • Experience with preparation of cost analysis on extra contractual benefit requests.

Requirements: Expertise Nursing Job Type Full-Time Regular Location IL - Chicago, TX - Richardson


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