On-site Holistic Health Specialist - High Cost - Registered Nurse (RN) - Downtown Dallas
This role will be supporting a dedicated client account and is located on-site at the C1 Innovation Lab in the West End in Downtown Dallas.
• The initial training for this position will be for approximately 4-weeks in Richardson, TX.
THIS POSITION IS BASED ON-SITE AND IS NOT WORK FROM HOME (WFH) / TELECOMMUTE.
C1 Innovation Lab (Downtown Dallas) -- Helping Customers Reimagine the Purpose of Health Insurance
Opened in August 2017 in the West End, the C1 Innovation Lab is a high-rise development housing HCSC in the Heart of Dallas. This is a place where we put our customers first while we imagine, explore, nurture and activate on their behalf. This facility serves as a beacon for customers to show them how committed we are to generating forward-thinking solutions that reduce health care expenses and improve health outcomes. It complements existing functions and infuses innovation into our daily operations.
Learn more here and see how we're putting our Customers first: http://c1innovationlab.com/
At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" as one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.
Join us and grow your career as we do everything in our power to stand with our members in sickness and in health!
This position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care. Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost effective outcomes; and serves as liaison to physicians and members. Other functions also include determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member. Handle immediate post discharge follow-up or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members. Provide oversight to Holistic Health Coordinators.
• Registered Nurse (RN) with current, valid, unrestricted license in The State of Texas
• 2 years of clinical practice experience as an RN providing direct clinical care to patients/customers/members
• 1 year of experience in care management/condition management in a health insurance/managed care setting
• PC proficiency to include Word, Excel, Lotus Notes and database experience
• Clear and concise verbal and written communication skills
• Familiarity of ancillary services including HHC, SNF, Hospice, etc
• Analytical skills
• Decision making skills and sound clinical judgment to provide oversight of other staff
• 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:
• High Cost experience
• 2 or more years of Case Management experience as an RN working in Health Insurance/Managed Care, Home Health or Acute Care
• Experience in managing complex or catastrophic health cases
• Recent experience clinical support either telephonic or in-person working with members/patients with chronic illnesses, including Diabetes, CAD, hypertension, CHF, COPD
• Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
• Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
• Knowledge of Milliman Guidelines or similar clinical guidelines
• Knowledge of medical management policies and procedures
• CCM or CDE
• Experience with Motivational Interviewing or other behavior change communication techniques
• Prior experience working in an innovative, collaborative and open office environment
• Experience working with a dedicated unit or on a custom account/client management
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 TX - Dallas
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