At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health need.

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.

This position is Remote / Telecommute

RN - Multistate License

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 :

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

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement :

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace.

Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Last updated : 2024-05-07