• Job Description

  Req#: R0037400

  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.

  Job Summary

  Position is responsible for performing concurrent review in accordance with accepted department criteria; performing discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost-effective services. Consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost effective outcomes. Serving as liaison to physicians, and members; serving as preceptor for less experienced staff.

  Job requirements:

  • Register Nurse (RN) with current, valid, unrestricted license in state of operations (TX, OK, NM) or reciprocity.
  • At least 1 year experience in Infertility and Mother/Baby specialties (Labor & Delivery, Post-Partum, NICU, Lactation, etc).
  • 2 years of clinical experience of direct clinical care to the consumer.
  • 1 year experience in health insurance/managed care.
  • Customer Service oriented.
  • PC proficiency to include Word, Excel, Outlook and database experience.
  • Clear and concise verbal and written communication skills.
  • 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. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

  
  Preferred job requirements:

  • CCM Certification required.
  • 3 years clinical experience.
  • Experience in Disease Management.
  • Experience in managing complex or catastrophic cases.
  • Working toward CM certification or Advanced degree.
  • Knowledge of medical management policies and procedures.
  • Bilingual a plus

  **Must have at least 1 year experience in Infertility and Mother/Baby specialties (Labor & Delivery, Post-Partum, NICU, Lactation, etc).

  #LI-Remote

  This is a Telecommute (Remote) role for TX, OK and NM: Must reside anywhere within the posted State(s) or within 250 miles from the office.
  

  Sponsorship is not available.

  The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Performance Incentive (Bonus) plan.

  We encourage people of all backgrounds and experiences to apply.

  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

• About the company

  Health Care Service Corporation (HCSC) is the largest member-owned health insurance company in the United States. HCSC offers a wide variety of insurance products and related services through Blue Cross and Blue Shield® of Illinois, Blue Cross and Bl...

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