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Job Summary
This position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care.
Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs.
Promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.
Other functions also include determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition.
Establish relationship with the member.
Handle immediate post discharge follow-up or until all short-term care needs are met.
Provide education/local resource information and encourage member (self) education.
Functioning in a clinical care advisory role, assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.
Provide oversight to holistic health coordinators.
JOB REQUIREMENTS: Registered Nurse (RN) with current, valid, unrestricted license in state of operations 2 years of clinical practice experience of direct clinical care to the customer 1 year of experience in care management/condition management in a health insurance/managed care setting PC proficiency to include Word, Excel, Lotus Notes and database experience Clear and concise verbal and written communication skills Familiarity of ancillary services including HHC, SNF, Hospice, etc Analytical skills Decision making skills and sound clinical judgment to provide oversight of other staff PREFERRED JOB REQUIREMENTS: Case Management experience Experience in managing complex or catastrophic health cases Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management) Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree Knowledge of Milliman Guidelines or similar clinical guidelines Knowledge of medical management policies and procedures
This position REMOTE
Work schedule: Monday - Friday 9:30 AM - 6:00 PM Are you being referred to one of our roles?
If so, ask your connection at HCSC about our Employee Referral process! 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