Care Coordinator UM/CM II
Job ID: KNH-1020135 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".
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 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:
- NICU Experience
- 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.
Telecommute is optional only to full time telecommuters in Texas or Illinois
Requirements: Expertise Nursing Job Type Full-Time Regular Location IL - Chicago, TX - Richardson, MT - Helena, OK - Tulsa, NM - Albuquerque
Meet Some of HCSC's Employees
Allison audits operational and financial data throughout the business, helping to expose and mitigate risks, ensure compliance, and add value to HCSC’s operations as a whole.
Back to top