At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
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 members. 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, assessing 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:
* Must have an active and unrestricted Compact Nursing license.
* Case Management experience is needed
* 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
* Work Hours are in the Central Standard Time Zone (9:30 AM to 6 PM CST Monday through Friday) and must be willing to work in that Time Zone (CST).
#LI-FW1
#LI-Remote
This is a Remote/Work-From-Home role. Must have an active and unrestricted Compact Nursing license.
Work Hours are in the Central Standard Time Zone (9:30 AM to 6 PM CST Monday through Friday) and must be willing to work in that Time Zone (CST).
Sponsorship is not available
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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.
$61,500.00 - $136,100.00
Exact compensation may vary based on skills, experience, and location.
Health Care Service Corporation serves nearly 23 million people across the United States through its portfolio of health benefit solutions.
HCSC provides health coverage options for employers large and small, individuals and families, and Medicare and Medicaid plans. HCSC also offers related health care products and services such as pharmacy solutions, life and dental insurance, and health data technology. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross Blue Shield Association.
For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs.
Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry.
As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible.
Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, 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, gender, national origin, disability, or protected veteran status.
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