Health Care Service Corporation
Holistic Health Specialist - C1 Lab (Hybrid)
Health Care Service Corporation, Dallas, Texas, United States, 75215
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.C1 Innovation Lab (Dallas)
Helping Customers Reimagine the Purpose of Health Insurance. Opened in August 2017 in the West End, C1 Innovation Lab is a high-rise development in the Heart of Dallas. This is a place where we put our members first while we imagine, explore, nurture, and activate on their behalf. This facility serves as a beacon for customers to show them how committed we are to generate forward-thinking solutions that reduce health care expenses and improve health outcomes. It will complement existing functions and infuse innovation into our daily operations. This role will have both clinical and innovation functions.This 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 member. 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, 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. Provide oversight to holistic health coordinators.JOB REQUIREMENTS:
Registered Nurse (RN) with current, valid, unrestricted license in state of operations2 years of clinical practice experience of direct clinical care to the customer1 year of experience in care management/condition management in a health insurance/managed care settingPC proficiency to include Word, Excel, Lotus Notes and database experienceClear and concise verbal and written communication skillsFamiliarity of ancillary services including HHC, SNF, Hospice, etcAnalytical skillsDecision making skills and sound clinical judgment to provide oversight of other staffPREFERRED JOB REQUIREMENTS:
Experience in managing complex or catastrophic health casesSpecialty 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 degreeKnowledge of Milliman Guidelines or similar clinical guidelinesKnowledge of medical management policies and proceduresThis is a hybrid role in downtown Dallas in the West-EndYou must live in or near Dallas, TX for this roleWork schedule is Tues, Weds and Thurs in office and Mon & Friday remoteRelocation assistance will not be provided for this position.Sponsorship will not be provided for this position.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.
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Helping Customers Reimagine the Purpose of Health Insurance. Opened in August 2017 in the West End, C1 Innovation Lab is a high-rise development in the Heart of Dallas. This is a place where we put our members first while we imagine, explore, nurture, and activate on their behalf. This facility serves as a beacon for customers to show them how committed we are to generate forward-thinking solutions that reduce health care expenses and improve health outcomes. It will complement existing functions and infuse innovation into our daily operations. This role will have both clinical and innovation functions.This 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 member. 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, 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. Provide oversight to holistic health coordinators.JOB REQUIREMENTS:
Registered Nurse (RN) with current, valid, unrestricted license in state of operations2 years of clinical practice experience of direct clinical care to the customer1 year of experience in care management/condition management in a health insurance/managed care settingPC proficiency to include Word, Excel, Lotus Notes and database experienceClear and concise verbal and written communication skillsFamiliarity of ancillary services including HHC, SNF, Hospice, etcAnalytical skillsDecision making skills and sound clinical judgment to provide oversight of other staffPREFERRED JOB REQUIREMENTS:
Experience in managing complex or catastrophic health casesSpecialty 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 degreeKnowledge of Milliman Guidelines or similar clinical guidelinesKnowledge of medical management policies and proceduresThis is a hybrid role in downtown Dallas in the West-EndYou must live in or near Dallas, TX for this roleWork schedule is Tues, Weds and Thurs in office and Mon & Friday remoteRelocation assistance will not be provided for this position.Sponsorship will not be provided for this position.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.
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