Care Coordinator UM/CM II
| Company | HCSC |
|---|---|
| Location | Nashville, TN, USA, Albuquerque, NM, USA, Chicago, IL, USA, Tulsa, OK, USA, Springfield, IL, USA, Richardson, TX, USA, Helena, MT, USA |
| Salary | $60300 – $133400 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
Requirements
- Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.
- 3 years clinical practice experience.
- 1 year Health Insurance/Managed Care experience.
- Knowledge of clinical utilization management/case management activities and standardized criteria set.
- Knowledge of managed care and insurance industry.
- Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
- Verbal and written communication skills; analytical skills; sound clinical judgment.
- PC proficiency to include Microsoft Word, Excel and Access.
- Current driver’s license.
- Ability and willingness to travel.
- 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.
Responsibilities
- Perform concurrent review and case management activities in discharge planning in accordance with approved departmental guidelines.
- Collaborate with healthcare providers, members, and business partners to optimize member benefits with evaluation medical necessity and promote effective use of resources.
- Apply Case Management principles in coordinating resources necessary to implement treatment options to meet the individual’s health needs.
Preferred Qualifications
- Working toward CM certification or advanced degree.
- Experience managing complex or catastrophic cases.
- Experience in Disease Management.
- Knowledge of Medical Management policies and procedures.
- Familiarity with medical guidelines (M&R, Interqual, etc.).
- Preparation of cost analysis on extra contractual benefit requests.