We are the Health Care Management division of HCSC — a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.
We're also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.
We currently have an immediate opportunity in Chicago-IL, Downers Grove-IL, Waukegan, IL, Tulsa, OK, and Richardson-TX for the following role:
Oncology Primary Nurse Case Administrator I Job Number: AK-1035001
This positions primary focus is the management of members with an oncology diagnosis. This position may be responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all other entities involved in managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and 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. Other functions also include episodic case management, determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member through the immediate post discharge follow-up period or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, the Primary Nurse Coordinator assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.
* Registered Nurse (RN) with current, valid, unrestricted license in The State of Illinois, Texas or reciprocity * 2 years of clinical practice experience as an RN providing direct clinical care to the patient/customer/member * 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician's office or hospital setting * 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. Incumbents with other clinical licenses are not required to obtain multi-state licenses
PREFERRED JOB REQUIREMENTS:
* Current certification in one of the following: ONS / ONCC / AOCN / CPON / AOCNP or other acceptable oncology nurse * Current CCM * Oncology clinical experience * 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) * Knowledge of Milliman Guidelines or similar clinical guidelines * Knowledge of medical management policies and procedures * Experience in managing complex or catastrophic health cases
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.