Utilization Management Coord

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.

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Job Summary

This position is responsible performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to 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. Willingness and ability to 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:

• RN Compact License
• Utilization management experience.
• MCG Certification.

This position is Remote

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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