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 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).
Act as a single source of contact for members, healthcare personnel, and other entities involved in managing care.
Conduct concurrent review, discharge planning, and care coordination.
Identify alternate treatment programs and evaluate options and services to meet health needs.
Promote quality and cost-effective outcomes and serve 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 immediate post-discharge follow-up until short-term care needs are met.
Provide education and local resource information to encourage member self-education.
Assess members for wellness education and disease management in a clinical care advisory role.
Introduce members to website tools and educate them on wellness and specific conditions.

Registered Nurse (RN) with current, valid, unrestricted license
2 years of clinical practice experience providing direct clinical care
1 year of experience in Condition Management or Case Management in a healthcare setting
PC proficiency including 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
Analytical skills and sound clinical judgment

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

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

Education:

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

Equal Opportunity Employment statement ensuring a welcoming environment.
Multi-state license fees will be provided by HCSC for incumbents requiring additional licenses.