Job ID: KB-1027429 Description:
This role will be supporting a dedicated client account and is located onsite at the C1 Innovation Lab in the West End in Downtown Dallas. The initial training for this position will be for approximately 4-weeks in Richardson, TX.
C1 Innovation Lab (Downtown Dallas) -- Helping Customers Reimagine the Purpose of Health Insurance
Opened in August 2017 in the West End, the C1 Innovation Lab is a high-rise development housing HCSC in the Heart of Dallas. This is a place where we put our customers first while we imagine, explore, nurture and activate on their behalf. This facility serves as a beacon for customers to show them how committed we are to generating forward-thinking solutions that reduce health care expenses and improve health outcomes. It complements existing functions and infuse innovation into our daily operations.
Learn more here and see how we're putting our Customers first: http://c1innovationlab.com/
At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.
Join us and grow your career as we do everything in our power to stand with our members in sickness and in health!
This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individuals benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individuals health needs; and may serve as a preceptor for less experienced staff.
Registered Nurse (RN) with current, valid, unrestricted license to practice in The State of Texas.
3 years clinical practice experience as an RN.
1 year Health Insurance/Managed Care experience.
Knowledge of clinical utilization management/case management activities and standardized criteria set.
Knowledge of managed care and insurance industry.
Familiarity of ancillary services including HHC, SNF, Hospice, Etc.
Verbal and written communication skills; analytical skills; sound clinical judgment.
PC proficiency to include Microsoft Word, Excel and Access.
PREFERRED JOB REQUIREMENTS:
Working toward CM certification or advanced degree.
Experience managing complex or catastrophic cases.
Experience in Disease Management.
Knowledge of Medical Management policies and procedures.
Familiarity with medical guidelines (M&R, Interqual, etc.).
Preparation of cost analysis on extra contractual benefit requests.
Patient Education, Condition Management and/or Case Management experience.
Bilingual in English and Spanish is a plus.
Recent experience either telephonic or in person clinical support working with patients with chronic illnesses, including Diabetes, CAD, hypertension, CHF, COPD.
CDE, Case Management Certification or nationally recognized health care certification.
Experience with Motivational Interviewing or other behavior change communication techniques.
Training, Facilitating and/or Presentation experience.
Interfacing with Senior Leadership, Executives and/or Clients.
Experience in working with a dedicated unit or custom account/client management.
Prior experience working in an innovative, collaborative and open office environment is a plus.
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.
Expertise Nursing Job Type Full-Time Regular Location TX - Dallas