Health Care Service Corporation
Imagine Something New, Something Different. See the world in fresh and vibrant ways. When you reimagine, perspectives change, potential is created and productive energy results. Health Care Service Corporation, a Mutual Reserve Company (HCSC), enjoys a proud history of performance, based on an unwavering commitment to our purposeāto do everything in our power to stand with our members in sickness and in healthĀ®āand the opportunities afforded our employees have to make it real. HCSC is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping our 15 million members with information and tools so they can make the best health care decisions for themselves and their families. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to join us and discover what new ways of imagining can mean for you, your community, our customers and our organization.
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. Join HCSC and be part of a purpose-driven company that will invest in your professional development.
JOB REQUIREMENTS: Registered Nurse (RN) with current, valid, unrestricted license in state of operations 4 years clinical practice experience of direct clinical care, to include 3 years of recent Specialty (Diabetes) clinical experience Knowledge of specialty diagnosis drugs, adjunct therapies and treatment protocols including side effects and complications Current certification in one of the following: CDE/CDCES PC proficiency to include Word, Excel, 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. Knowledge of drugs and treatment protocols including side effects and complications Knowledge of diets relating to assist members Knowledge of Problem Solving, Healthy Coping and establishing SMART goals. Current Certified Specialists must maintain their certification PREFERRED JOB REQUIREMENTS: RN Compact license required 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
This positionās primary focus is the management of members with specialty (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 individualās 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.
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