Case Management Coordinator II (NICU/Infertility/Mother Baby)

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Job Summary

Position is responsible for performing concurrent review in accordance with accepted department criteria; performing discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost-effective services. Consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost effective outcomes. Serving as liaison to physicians, and members; serving as preceptor for less experienced staff.

Job requirements:

• Register Nurse (RN) with current, valid, unrestricted license in state of operations (TX, OK, NM) or reciprocity.
• At least 1 year experience in Infertility and Mother/Baby specialties (Labor & Delivery, Post-Partum, NICU, Lactation, etc).
• 2 years of clinical experience of direct clinical care to the consumer.
• 1 year experience in health insurance/managed care.
• Customer Service oriented.
• PC proficiency to include Word, Excel, Outlook and database experience.
• Clear and concise verbal and written communication skills.
• 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:

• CCM Certification required.
• 3 years clinical experience.
• Experience in Disease Management.
• Experience in managing complex or catastrophic cases.
• Working toward CM certification or Advanced degree.
• Knowledge of medical management policies and procedures.
• Bilingual a plus

**Must have at least 1 year experience in Infertility and Mother/Baby specialties (Labor & Delivery, Post-Partum, NICU, Lactation, etc).

#LI-Remote

This is a Telecommute (Remote) role for TX, OK and NM: Must reside anywhere within the posted State(s) or within 250 miles from the office.  
 

Sponsorship is not available.

The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Performance Incentive (Bonus) plan.

We encourage people of all backgrounds and experiences to apply.

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