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Utilization Management Coordinator - (RN) - Richardson, TX

Company: Health Care Service Corporation
Location: Richardson
Posted on: October 2, 2021

Job Description:

Description:

~~ $5000 SIGN ON BONUS ~~

** BONUS applies only to this position Job ID # DLP-1044437 **

*** Position is Telecommute within 100 miles of Richardson Headquaters ***

BASIC FUNCTION:

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. This position reviews service requests, 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, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities. This position will be engaged with Utilization Management Review.

JOB REQUIREMENTS:
* Registered Nurse (RN) with valid, current, unrestricted license in The State required.
*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, on a rare occasion, if needed.

PREFERRED JOB REQUIREMENTS:
* 2+ years of Utilization Management experience is preferred.
* 3 years of clinical experience in various environments including: acute hospital setting, physician office, LTACH/SNF, home health, surgical setting or health care insurance company.
* In-patient nursing experience.
* Specialty RN experience - Oncology, NICU, O/R, Cardio, etc. - a variety of clinical experience is preferred - NOT limited to NICU or Maternal Health
* Intensive Care and/or Critical Care experience is preferred.
* Case Management, Care Management, Condition Management and/or Disease Management experience is a plus.
* MCG Certification is a plus.

* Sign on Bonus is only applicable for applicants hired prior to 12.31.21
*CA

#LI-DP1

Location: TX - Richardson
Activation Date: Friday, August 13, 2021
Expiration Date: Saturday, January 1, 2022

Keywords: Health Care Service Corporation, Richardson , Utilization Management Coordinator - (RN) - Richardson, TX, Other , Richardson, Texas

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