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
This Position Is Responsible For Conducting Audits As Well As Monitoring Ongoing Quality Improvement Activities Within The Medical Management Program; Analyzing Compliance With Departmental Policies, Regulatory And Accrediting Requirements, And Preparing Reports For Management Presentation To Internal Ancillary Departments And Committees; And Serving As A Resource To Internal Ancillary Departments On Quality And Utilization Issues And Contributing To Accreditation Survey Processes.
Required Job Qualifications:
- Registered Nurse (RN), Licensed Practical Nurse (LPN), OR Behavioral Health Professional with unrestricted license to practice in state of operations.
- 3 years clinical experience, including 2 years utilization review or case management experience.
- Quality improvement experience.
- Working knowledge of the Medical Management Program and UM/CM policies and practices.
- Analytical skills.
- Verbal and written communication skills.
- PC experience utilizing Microsoft Office software.
Preferred Job Qualifications:
- 3-5 years Case Management experience.
- Bachelor Degree in Nursing or Health Administration or in the healthcare field
- Certified Professional Health Care Quality (CPHQ Certification)
*CA
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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
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What We Do
Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
