Job Title: Primary Nurse Coordinator (Remote)

Company: Health Care Service Corporation (HCSC)

Location: Remote (Must reside within 250 miles of the office or anywhere within the posted state)

Job Description:

At HCSC, our employees are the cornerstone of our business, and we are committed to investing in their professional growth and development. Join a purpose-driven organization that empowers you to grow and succeed in a rewarding career.

The Primary Nurse Coordinator is responsible for performing all functions of Utilization Management (UM), Case Management (CM), and Disease Management (DM). This role acts as a single point of contact for members, healthcare personnel, and other entities involved in managing care. The position involves concurrent review, discharge planning, care coordination, and consultation with physicians, providers, and members to ensure high-quality and cost-effective care outcomes.

The role also includes episodic case management, pre-admission/post-discharge counseling, and providing education and local resource information to members. The Primary Nurse Coordinator fosters relationships with members through post-discharge follow-ups and educates them about wellness and specific conditions, all while facilitating the coordination of care.

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Key Responsibilities:

Conduct concurrent reviews, discharge planning, and care coordination to meet the health needs of members.
Identify alternate treatment programs and consult with physicians, providers, and members to evaluate care options.
Promote quality and cost-effective outcomes and serve as a liaison to physicians and members.
Perform episodic case management and provide pre-admission/post-discharge counseling.
Educate members on wellness, specific conditions, and local resources.
Facilitate care coordination for identified members and introduce them to website tools and resources.
Work with complex and high-risk members, helping them manage their conditions and improve their health outcomes.

Job 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 health insurance, managed care, physician office, or hospital setting.
Proficiency in Microsoft Office (Word, Excel, Lotus Notes) and database systems.
Strong verbal and written communication skills.
Knowledge of UM/CM/DM activities and standardized clinical criteria.
Familiarity with ancillary services (e.g., Home Health Care, Skilled Nursing Facilities, Hospice).
Sound clinical judgment and analytical skills.

Preferred Qualifications:

Experience in managing complex or catastrophic health cases.
Specialty clinical experience in areas such as intensive care, orthopedic, NICU/pediatric, oncology, diabetes management, or obstetrics.
Working toward or completion of CCM/CCP/CDE certification or an advanced degree.
Knowledge of Milliman Guidelines or similar clinical guidelines.
Familiarity with medical management policies and procedures.

Compensation:

Base Salary: $60,300 – $133,400 per year.
Compensation may vary based on skills, experience, and location.

Why Join HCSC?

Work for a company that prioritizes employee growth and professional development.
Competitive compensation and benefits.
Be part of a diverse and inclusive workplace where your unique skills are valued.

Equal Opportunity Employment:

HCSC is an Equal Opportunity Employer and welcomes applicants from all backgrounds. We are committed to creating an inclusive environment where diversity is celebrated and respected.

How to Apply: Are you ready to make an impact by helping others while growing in a fulfilling career? Apply today to join the HCSC team!

Primary Nurse Case Admin ID-4021