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Primary Nurse Case Admin I - UM - TX
Health Care Service Corporation - Richardson, TX
posted about 2 months ago
About the position
The Primary Nurse Coordinator at HCSC is responsible for managing Utilization Management (UM), Case Management (CM), and Disease Management (DM) functions. This role serves as a single point of contact for members and healthcare personnel, performing concurrent reviews, discharge planning, and care coordination. The coordinator promotes quality outcomes and cost-effective care while providing education and resources to members. This position is fully remote, requiring the ability to manage care effectively and establish relationships with members post-discharge.
Responsibilities
- Perform all functions of Utilization Management (UM), Case Management (CM), and Disease Management (DM).
- Serve as a single source of contact for members and healthcare personnel.
- Conduct concurrent reviews and discharge planning.
- Identify alternate treatment programs and consult with physicians and providers.
- Evaluate options and services required to meet individual health needs.
- Promote quality and cost-effective outcomes.
- Establish relationships with members during the post-discharge follow-up period.
- Provide education and local resource information to members.
- Assess members for wellness education and disease management.
- Facilitate coordination of care for identified members.
Requirements
- Registered Nurse (RN) with a current, valid, unrestricted license in the state of operations.
- 2 years of clinical practice experience providing direct clinical care.
- 1 year of experience in Condition Management or Case Management in a relevant setting.
- Proficiency in PC applications including Word, Excel, and database management.
- Clear and concise verbal and written communication skills.
- Knowledge of UM/CM/DM activities and standardized criteria.
- Familiarity with ancillary services such as HHC, SNF, and Hospice.
- Strong analytical skills and sound clinical judgment.
Nice-to-haves
- Experience in managing complex or catastrophic health cases.
- Clinical experience in Med/Surg, telemetry, etc.
- Working toward or completion of CCM/CCP/CDE certification or an advanced degree.
- Knowledge of Milliman Guidelines or similar clinical guidelines.
- Knowledge of medical management policies and procedures.
Benefits
- Competitive salary range from $58,800.00 to $130,100.00.
- Remote work opportunity with 100% telecommuting in Texas.
- Rotating weekend shifts once a month.
