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.

Responsible For Focusing On The Overall Health Of The Member By Assisting The Member With The Goal Of Increased Health. Overall Wellbeing By Developing A One-To-One Relationship With The Member. Encourage Members To Utilize Appropriate Resources And Web Based Tools Available To Them To Access Information Regarding Their Condition As Well As Track Progress Towards Wellbeing Goals. This Position Is Also Responsible For Guiding The Member Through Transitions In Care, Handling A Member *S Complex Needs As Well As Acute And Chronic Conditions. Additionally, This Position Will Receive Referrals Focusing On Member Wellbeing; Including Diagnosis Based, Overall Medical Cost, Identified Treatment Gaps, Frequent Emergency Room Utilization, Pre-Admission/Post-Discharge Follow-Up, Etc.

Required Job Qualifications:

• Registered Nurse (RN) with current, valid, unrestricted license in state of operations
• 2 years of clinical practice experience of direct clinical care to the consumer
• 1 year of experience in care management/condition management
• PC proficiency to include Word, Excel, Outlook and database experience
• Clear and concise verbal and written communication skills
• Familiarity of ancillary services including HHC, SNF, Hospice, etc
• Analytical skills
• Decision making skills and sound clinical judgment to provide oversight of other staff

Preferred Job Qualifications:

• 3 years of clinical practice experience of direct clinical care to the consumer
• Experience in managing complex or catastrophic health cases
• Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
• Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
• Knowledge of Milliman Guidelines or similar clinical guidelines
• Knowledge of medical management policies and procedures

This role is a Telecommute role.

Requires 4-6 months of on-site training 3 days a week

#LI-Remote

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.