Remote Pediatric Nursing Jobs in Rio Rancho, NM (NOW HIRING)

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Job SummaryThis position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care. 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 determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the members. Handle immediate post discharge follow-up 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, assessing 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. Provide oversight to holistic health coordinators.

JOB REQUIREMENTS:
* Registered Nurse (RN) with current, valid, unrestricted license in state of operations
* 2 years of clinical practice experience of direct clinical care to the customer
* 1 year of experience in care management/condition management in a health insurance/managed care setting
* PC proficiency to include Word, Excel, Lotus Notes 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 REQUIREMENTS:
* Must have an active and unrestricted Compact Nursing license.
* Case Management experience is needed
* 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
* Work Hours are in the Central Standard Time Zone (9:30 AM to 6 PM CST Monday through Friday) and must be willing to work in that Time Zone (CST).

#LI-FW1

#LI-Remote
This is a Remote/Work-From-Home role. Must have an active and unrestricted Compact Nursing license.
Work Hours are in the Central Standard Time Zone (9:30 AM to 6 PM CST Monday through Friday) and must be willing to work in that Time Zone (CST).

Sponsorship is not available

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 plansubject to the terms and the conditions of the plan.

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.

Base Pay Range$61,500.00 - $136,100.00

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