Job ID: SD-1031292 Description:
We are the Health Care Management division of HCSC a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.
We're also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.
This position will be responsible for focusing on the overall health of the member by assisting the member with the goal of increased health and overall wellbeing by developing a one-to-one relationship with the member. Encourage members to utilize appropriate resources and web based tools available to them to access information regarding their condition as well as track progress towards wellbeing goals. This position is also responsible for guiding the member through transitions in care, handling a member
Registered Nurse (RN) with current, valid, unrestricted license in state of operations
2 years of clinical practice experience of direct clinical care to the consumer
1 year of experience in care management/condition management
PC proficiency to include Word, Excel, Outlook and database experience
Clear and concise verbal and written communication skills
Familiarity of ancillary services including HHC, SNF, Hospice, etc
Decision making skills and sound clinical judgment to provide oversight of other staff
Preferred Job Qualifications:
3 years of clinical practice experience of direct clinical care to the consumer
Experience in managing complex or catastrophic health cases
Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
Knowledge of Milliman Guidelines or similar clinical guidelines
Knowledge of medical management policies and procedures
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 IL - Chicago, TX - Richardson