Match score not available

Unlock Premium Benefits Today!
🚀 Elevate your career with priority access.
Stand out to top recruiters with Jobgether Priority Access:
  • ✅ Top Match: We help you identify job offers where you're a perfect fit.
  • ✅ Exclusive Referral Service: Connect directly with recruiters as a Jobgether Certified Premium User.
  • ✅ Personalized Feedback: Receive feedback and expert guidance on applications, and have your profile manually reviewed.

Start Your Free Trial Now!

Start my free trial

Utilization Management Coordinator - Health Advocacy Solutions (Texas)

Remote: 
Full Remote
Contract: 
Full time
Salary: 
60 - 133K yearly
Experience: 
Mid-level (2-5 years)
Work from: 
Texas (USA), United States

Offer summary

Qualifications:

Registered Nurse (RN) with valid license, 3 years of clinical experience, Knowledge of medical terminology, MCG Certification preferred.

Key responsabilities:

  • Perform initial and concurrent review activities
  • Collect and verify clinical data and eligibility
Health Care Service Corporation logo
Health Care Service Corporation XLarge https://www.hcsc.com/
10001 Employees
About Health Care Service Corporation
Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, 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, gender, national origin, disability, or protected veteran status.
See all jobs

Job description

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 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. 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. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. Willingness and ability to travel when needed.

JOB REQUIREMENTS:
  • Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience 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:
  • RN Compact License required
  • Utilization management experience.
  • MCG Certification.

This is a 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!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

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
$60,300.00 - $133,400.00

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Medical TerminologyUtilization ManagementClinical ExperienceNursingCare CoordinationClinical Data AnalysisNurse Licensure Compact

Other Skills

  • Report Writing
  • Communication
  • Non-Verbal Communication
Are you interested?

Operations Manager Related jobs

See more Operations Manager jobs