Primary Nurse Case Admin l - TX

Registered Nurse (RN) with current, valid, unrestricted license in state of operations 2 years clinical practice experience of direct clinical care to the customer 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting. PC proficiency to include Word, Excel, Lotus Notes and database experience Clear and concise verbal and written communication skills Knowledge of UM/CM/DM activities and standardized criteria set Familiarity of ancillary services including HHC, SNF, Hospice, etc Verbal and written communication skills; analytical skills; sound clinical judgment Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses. PREFERRED JOB REQUIREMENTS: 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 certification or Advanced degree Knowledge of Milliman Guidelines or similar clinical guidelines Knowledge of medical management policies and procedures Compact and California license Sun-Thurs 10a-6:30p This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. #LI-Remote

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