Care Coordinator UM/CM II
This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individuals benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individuals health needs; and may serve as a preceptor for less experienced staff.
• Registered Nurse (RN) with current, valid, unrestricted 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.
• Current drivers license.
• Ability and willingness to travel.
PREFERRED JOB REQUIREMENTS:
• Working toward CM certification or advanced degree.
• Experience managing complex or catastrophic cases.
• Experience in Disease Management.
• Knowledge of Medical Management policies and procedures.
• Familiarity with medical guidelines (M&R, Interqual, etc.).
• Preparation of cost analysis on extra contractual benefit requests.
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.
Requirements: Expertise Nursing Job Type Full-Time Regular Location IL - Chicago, TX - Richardson
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