Medical Reviewer II - RN (Tx, OK, NM, MT & IL)

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

THIS IS A TELECOMMUTER POSITION FOR THE 5 PLANS (TX, OK, NM, MT & IL) PLANS

Computer proficiency to include Microsoft Office (Word, Excel, PowerPoint, Access) and Outlook is a must

Training is 12-16 weeks. Training Hours are 8 AM to 4:30 PM (non-negotiable)

This position is responsible for performing accurate and timely medical review of regular business, State of Texas and National Accounts claims suspended for medical necessity, Contract interpretation, Pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations.

JOB REQUIREMENTS:

• Registered Nurse with current, active, unrestricted Registered Nurse (RN) license in the state of operations (TX, OK, NM, MT & IL). For Compact Licensee changing permanent residence to State of Operations: you must obtain an active, unrestricted RN licensure in the state of operations within 90 days of hire.

• 3 years clinical experience.

• Verbal and written communications skills.

• Analytical and decision-making skills.

• Customer Service experience

• PC and database experience.

#LI-Remote

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

We encourage people of all backgrounds and experiences to apply.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.