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.

This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care. Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services.

JOB REQUIREMENTS:

• LPN with valid, current, unrestricted clinical license in the state of operations.

• 3 years of clinical experience in physician office, hospital, or surgical setting.

• Customer service oriented to assist internal/external customers.

• Verbal and written communication skills.

• Interpersonal skills and ability to be a team player.

• Willingness and ability to travel.

• Familiar with PC or database systems.

• 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. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

PREFERRED JOB REQUIREMENTS:

• LPN / LVN Multi-state License Preferred

• Utilization review or utilization management experience

• Strong organizational, planning, and communication skills

• Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10)

• Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.

Work Schedule: Weekend Rotation and Holiday Rotation (2 holidays per year)

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

Compensation: $45,000.00 - $100,100.00

Exact compensation may vary based on skills, experience, and location

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards