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 and Case Management Nurse

Job Type: Remote

Pay: $60,300.00 - $133,400.00

Shift:

Work Type: Telecommute

Address:

City: Richardson

State: TX

ZIP Code:

Perform all functions of Utilization Management (UM), Case Management (CM), and Disease Management (DM).
Act as a single source of contact for members, healthcare personnel, and all other entities involved in managing care.
Conduct concurrent review, discharge planning, and care coordination.
Identify alternate treatment programs and consult with physicians, providers, members, and other resources to evaluate options and services.
Promote quality and cost-effective outcomes while serving as a liaison to physicians and members.
Manage episodic case management and determine member assignment of treatment.
Provide pre-admission/post-discharge counseling for acute conditions.
Establish relationships with members during the immediate post-discharge follow-up period.
Provide education and local resource information to encourage member (self) education.
Assess members for wellness education and disease management.
Introduce members to website tools and facilitate coordination of care.

Registered Nurse (RN) with a current, valid, unrestricted license in the state of operations.
2 years of clinical practice experience in direct clinical care.
1 year of experience in Condition Management or Case Management in a relevant setting.
PC proficiency in Word, Excel, Lotus Notes, and databases.
Clear verbal and written communication skills.
Knowledge of UM, CM, DM activities, and standardized criteria.

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