Blue Cross and Blue Shield of Illinois, Montana, N Utilization Management Coordinator - Registered Nurse (RN) in Richardson, Texas


There are two positions associated with this posting.

* THIS POSITION IS INITIALLY BASED IN THE OFFICE IN RICHARDSON, TX - This position has the ability to work-from-home after training (approximately 1 year) subject to business needs if one is meeting their attendance and performance metrics. *

------------------------------------------------------------ At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.

Join us and grow your career as we do everything in our power to stand with our members in sickness and in health!

BASIC FUNCTION: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 Texas.3 years of clinical experience as a RN 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:3+ years of Utilization Management (UM) experience.MCG Certification.*BSN.

Location: TX - Richardson

Activation Date: Wednesday, December 5, 2018

Expiration Date: Friday, February 1, 2019

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