On-Site Primary Nurse Case Admin I - Registered Nurse (RN) - Downtown Dallas
This role will be supporting a dedicated client account and is located onsite 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 IS NOT A WORK-FROM-HOME (WFH) or TELECOMMUTE position.
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 infuse 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 all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all other entities involved in managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and care coordination; 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 episodic case management, determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member through the immediate post discharge follow-up period 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, the Primary Nurse Coordinator 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.
Registered Nurse (RN) with current, valid, unrestricted license in The State of Texas
•2 years of clinical practice experience with direct clinical care to the customer
•1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting.
•PC proficiency to include Word, Excel, Lotus Notes and database experience
•Clear and concise verbal and written communication skills
•Knowledge of UM/CM/DM activities and standardized criteria set
•Familiarity of ancillary services including HHC, SNF, Hospice, etc.
•Verbal and written communication skills; analytical skills; sound clinical judgment
•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:
Experience in managing complex or catastrophic health cases
•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 certification or Advanced degree
•Knowledge of Milliman Guidelines or similar clinical guidelines
•Knowledge of medical management policies and procedures
•Experience with Motivational Interviewing or other behavior change communication techniques
•Training, facilitation, educator, and/or patient education experience
•Strong presentation skills with prior experience speaking to groups, interacting with clients and senior leadership
•Experience in working with a dedicated unit or custom account/client management
•Prior experience working in an innovative, collaborative and open office environment
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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