Member Care Coordinator

Job ID: KNH-1019677 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 is a WFH position.

BASIC FUNCTION:

This position is responsible for performing medical management of pediatric member cases with chronic care and special needs. The position handles the evaluation of care plans designed to optimize the health care of the member. The position is responsible for needs assessments, service plan development, service authorization activities, and implementation and monitoring of individualized service plans. Perform telephonic clinical assessments. Work within an interdisciplinary team to achieve specific goals for the member.

JOB REQUIREMENTS:

  • Bachelor degree in Social Work or a Licensed Vocation Nurse (LVN).
  • 3 years clinical practice experience.
  • Experience with service coordination related to health care.
  • Knowledge of clinical utilization management/case management activities and standardized criteria set.
  • Knowledge of managed care and insurance industry.
  • Verbal and written communication skills; analytical skills; sound clinical judgment.
  • PC proficiency to include retrieving and entering data into databases.

PREFERRED JOB REQUIREMENTS:

  • Aerial experience highly desired.
  • 1 year health insurance/managed care experience.
  • Experience with pediatric special needs population.
  • Familiarity of Medicaid waivers and Long Term supports.
  • Working toward CM certification.
  • Experience managing medical management/clinical cases.
  • Experience in Disease Management."
  • Knowledge of Medical Management policies and procedures.
  • Familiarity with medical guidelines (M&R, Interqual, etc.).
  • Experience with Texas Medicaid programs.
  • Bilingual, English/Spanish, a plus.
  • Experience with Microsoft Office applications.

LI-POST

  • CB*
  • CA

Requirements: Expertise General Health Care Job Type Full-Time Regular Location TX - Richardson, TX - Austin


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