Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary **THIS IS A TELECOMMUTER ROLE FOR THE ALBUQUERQUE HEADQUARTERS OFFICE. YOU MUST BE WILLING AND ABLE TO WORK IN THE OFFICE 6 MONTHS (FOR TRAINING) BEFORE YOU CAN FULLY TELECOMMUTE****Work Hours: Sunday through Thursday 8 AM - 5 PM **
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.
JOB REQUIREMENTS:
* Registered Nurse (RN) with valid, current, unrestricted license in the state of operations (New Mexico).
* 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.
PREFERRED JOB REQUIREMENTS:
* Utilization management experience.
* MCG Certification.
#LI-REMOTE
Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.
We encourage people of all backgrounds and experiences to apply.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
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.
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