Care Coordinator UM/CM II

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Job Summary

This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individual’s benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individual’s health needs; and may serve as a preceptor for less experienced staff.

JOB REQUIREMENTS:

• Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.
• 3 years clinical practice experience.
• 1 year Health Insurance/Managed Care experience.
• Knowledge of clinical utilization management/case management activities and standardized criteria set.
• Knowledge of managed care and insurance industry.
• Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
• Verbal and written communication skills; analytical skills; sound clinical judgment.
• PC proficiency to include Microsoft Word, Excel and Access.
• Current driver’s license.
• Ability and willingness to travel.
• 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.
• REMOTE WORK

PREFERRED JOB REQUIREMENTS:

• Working toward CM certification or advanced degree.
• Experience managing complex or catastrophic cases.
• Experience in Disease Management.
• Knowledge of Medical Management policies and procedures.
• Familiarity with medical guidelines (M&R, Interqual, etc.).
• Preparation of cost analysis on extra contractual benefit requests.

*CA

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$58,800.00 - $130,100.00 Apply