What are the responsibilities and job description for the Primary Nurse Case Admin I ONSITE position at Health Care Service Corporation?
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Job Summary
This position is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all other entities involved in managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and care coordination; 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 episodic case management, determining member assignment of treatment, and pre-admission / post-discharge counseling for an acute condition. Establish relationship with the member through the immediate post discharge follow-up period 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, the Primary Nurse Coordinator 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.
JOB REQUIREMENTS :
- Registered Nurse (RN) with current, valid, unrestricted license in state of operations
- 2 years clinical practice experience of direct clinical care to the customer
- 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting.
- PC proficiency to include Word, Excel, Lotus Notes and database experience
- Clear and concise verbal and written communication skills
- Knowledge of UM / CM / DM activities and standardized criteria set
- Familiarity of ancillary services including HHC, SNF, Hospice, etc
- Verbal and written communication skills; analytical skills; sound clinical judgment
- 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 :
This is a Telecommute (Remote) role : Must reside withing 250 miles of the office or anywhere within the posted state.
LI-Remote
INAK
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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 .
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.
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
60,300.00 - $133,400.00
Salary : $60,300 - $133,400
