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
Summary:
This position is responsible performing initial, concurrent review activities such as discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services. Will serve as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies policy and HIPPA eligibility. Determines benefit levels in accordance with contract guidelines. Prepares reports on quality of care, identifies and reports cases. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.
Note: This position currently does not require travel.
JOB REQUIREMENTS:
- Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
- 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
- Knowledge of medical terminology and procedures.
- Verbal and written communication skills.
- Willingness and ability to travel.
PREFERRED JOB REQUIREMENTS:
- Utilization management experience HIGHLY PREFERRED.
- Professional use of Microsoft Office Suite (Excel, Word, PowerPoint, etc)
TELECOMMUTE
This position does not support sponsorship.
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
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.
