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Job SummaryThis position's primary focus is the management of members with specialty (oncology / diabetes) diagnoses. This position will be responsible for performing all functions of case management (cm) and is a primary source of contact for members, health care personnel and all other entities involved in managing specialty care. The primary nurse case administrator performs care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost- effective outcomes; and serves as liaison to physicians and members. Provide education/local resource information and encourage member (self) education functioning in a clinical care advisory role, the primary nurse case administrator assesses members for case management, introduces members to our website tools, educates members regarding their specific condition, and facilitates the coordination of care for identified members.This position is Remote / Telecommute
JOB REQUIREMENTS
Experience in managing complex or catastrophic health cases
Inpatient and Outpatient experience preferred.
1-year experience in Care Management in a health insurance/managed care setting
Current CCM certification
Knowledge of medical management policies and procedures
1-year education experience in Specialty area.
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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.