On Site Utilization Mgmt Coord
Job ID: AK-1019922 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 performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position conducts on-site reviews and assessments, reviews service requests, collects clinical and non-clinical data, verifies eligibility, determines benefit levels in accordance to contract guidelines, prepares reports on quality of care, identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities.
- Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
- 3 years of clinical experience in physician office, hospital/surgical setting or health insurance company.
- Knowledge of medical terminology and procedures.
- Verbal and written communication skills.
- Willingness and ability to travel.
PREFERRED JOB REQUIREMENTS:
- Utilization management experience.
- MCG Certification.
Requirements: Expertise Nursing Job Type Full-Time Regular Location TX - Houston
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