Utilization Management Coordinator

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 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:

• Utilization Management and/or Case Management experience.
• MCG Certification.

Schedule: Monday-Friday with weekend rotation every six weeks; and occasional holiday

This is a Telecommute (Remote) role:  Must reside within 250 miles of the office or anywhere within the posted state.
 

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are 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$60,300.00 - $133,400.00