Primary Nurse Case Administrator I - Registered Nurse (RN)

Job ID: KB-1020182 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 has the potential to Work-from-Home after applicant meets and/or exceeds production standards consistently for 6 months post-training and with management approval.

Internal HCSC candidates who currently Work From Home may resume working from home following their training and consistently meeting their metrics for 3 months post-training in the office subject to management approval.

BASIC FUNCTION:

This position is responsible for performing a variety of clinical 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 may perform some of the following: 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 a member health needs; promotes quality and cost effective outcomes; and serves as liaison to physicians and members. Other functions can 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, and provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, the Primary Nurse Coordinator may assess members for wellness education and disease management, introduce members to our website tools, educate members regarding wellness and specific conditions, and facilitate the coordination of care for identified members.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with current, valid, unrestricted license in state of operations.
  • 2 years clinical practice experience of direct clinical care to the customer.
  • 1 year experience in Condition Management or Case Management in a health insurance/managed care setting.
  • Case Management Certification (URAC accredited certification - CCM/CCP/CDE) or obtain URAC accredited case management certification within 18 months of starting in the role.
  • 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.

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).
  • Knowledge of Milliman Guidelines or similar clinical guidelines.
  • Utilization Management (UM) experience.
  • Knowledge of medical management policies and procedures.

Requirements: Expertise Nursing Job Type Full-Time Regular Location TELECOMMUTE, TX - Richardson


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