Clinical Stop Loss Nurse - Work From Home

Location: Richardson, TX, US, Albuquerque, New Mexico, United States, Chicago, Illinois, United States, Helena, Montana, United States, Tulsa, Oklahoma, United States

Employment Type: Full time

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.

This position is responsible for the review of case management notes, large claims reports and shock reporting for individuals and groups seeking stop loss insurance quotes and renewals. The position works closely with internal claim, clinical and case management teams to develop ongoing care and cost projections. The projections are then communicated to underwriting to help evaluate potential risk and associated costs.

Required Job Qualifications:

• Bachelors degree in nursing is preferred with current state licensure and at least 3-5 years of clinical experience
• 2-4 years experience with Stop Loss products and clinical programs
• Strong analytical and problem solving skills
• Excellent organizational and time management skills, able to work independently with little supervision while handling numerous projects at once
• Excellent written/verbal communication skills, especially the ability to communicate effectively with underwriting staff
• Ability to complete cost projections on new and renewal business within 24-48 hours of receipt
• Documentation with clinical summary and estimated cost of care for each individual identified as at risk
• Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
• Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel.

Preferred Job Qualifications:

• Clinical claims review and claims auditing 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)
• 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

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Compensation: $84,400.00 - $152,300.00

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

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards