Primary Nurse Case Administrator Specialty

Health Care Service Corporation
United States, Texas, Katy
Nov 13, 2024
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's primary focus is the management of members with specialty (oncology) 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 individual's 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. 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 (oncology / 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: ONS/ONCC/AOCN/CPON/AOCNP 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. 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 ONCOLOGY CERTIFICATION REQUIRED CCM Certification a plus 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 position is Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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$67,500.00 - $143,100.00