Case Management Coord II

HCSC • Abilene, TX

359d • $60,300 - $133,400 • Remote

About The Position

This 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.

Requirements

• Registered Nurse (RN) with current, valid, unrestricted license in state of operations or reciprocity.
• 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, Lotus Notes 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.

Nice To Haves

• 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 in Spanish/English or Polish/English.

Responsibilities

• Perform concurrent review in accordance with accepted department criteria.
• Conduct discharge planning and identify alternate treatment programs.
• Consult with physicians, providers, members, and other resources to assess health needs.
• Plan, facilitate implementation, coordinate, monitor, and evaluate options and services.
• Serve as a liaison to physicians and members.
• Act as a preceptor for less experienced staff.

Benefits

• 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
• Annual incentive bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees