Primary Nurse Case Admin I - IL, NM, TX

Health Care Service Corporation - Richardson, TX

Job Title: Primary Nurse Case Admin I - IL, NM, TX

Position: Utilization Management (UM), Case Management (CM), and Disease Management (DM) Nurse

Job Type: Telecommute

Pay: $60,300.00 - $133,400.00

Shift:

Work Type: Remote

Address:

City: Richardson

State: TX

ZIP Code:

Perform all functions of Utilization Management (UM), Case Management (CM), and Disease Management (DM).
Serve as a single source of contact for members, healthcare personnel, and all entities involved in managing care.
Conduct concurrent review, discharge planning, and care coordination.
Identify alternate treatment programs.
Consult with physicians, providers, members, and other resources to evaluate options and services required to meet health needs.
Promote quality and cost-effective outcomes.
Act as a liaison to physicians and members.
Provide episodic case management, determine member assignment of treatment, and offer pre-admission/post-discharge counseling for acute conditions.
Establish relationships with members during the immediate post-discharge follow-up period or until all short-term care needs are met.
Provide education and local resource information and encourage member self-education.
Assess members for wellness education and disease management.
Introduce members to website tools and educate them regarding wellness and specific conditions.
Facilitate coordination of care for identified members.

Registered Nurse (RN) with current, valid, unrestricted license in state of operations.
2 years clinical practice experience in direct clinical care.
1 year experience in Condition Management or Case Management in relevant settings.
Proficiency in Microsoft Word, Excel, Lotus Notes, and database usage.
Clear and concise verbal and written communication skills.
Knowledge of UM/CM/DM activities and standardized criteria.
Ability to analyze clinical information and exercise sound clinical judgment.

Compact license.
Experience in managing complex or catastrophic health cases.
Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, and obstetric management.
Working towards or completion of CCM/CCP/CDE certification or an advanced degree.
Knowledge of Milliman Guidelines or similar clinical guidelines.
Familiarity with medical management policies and procedures.

Experience: 2 years clinical practice experience; 1 year experience in Condition Management or Case Management.

Education:

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

HCSC is an Equal Opportunity Employment employer dedicated to providing a welcoming environment respecting and valuing unique differences of employees.