At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This position is responsible for facilitating member and provider appeals; working closely with Medical Directors and Customer Service to ensure appeal process meets established guidelines. Adhering to accreditation and regulatory requirements to meet audit standards. Managing individual inventory through appropriate workflow.

** This is a Telecommuter role for one of the following locations: Tulsa, OK; Albuquerque, NM; Richardson, TX; Chicago, IL; or Helena, MT office.**

** Weekend Rotation Required and holidays**

**Work Hours are 9:00 AM to 6:00 PM Monday through Friday**

JOB REQUIREMENTS:

• 5 years combine knowledge of healthcare processes.
• Registered Nurse (RN) with unrestricted license in state of operations.
• Knowledge of managed care processes.
• Organizational skills and ability to meet deadlines and manage multiple priorities.
• PC experience to include Microsoft Word, Access, and Excel.
• Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.

PREFERRED JOB REQUIREMENTS:

• Knowledge of state and federal health care and health operations regulations.
• Proficient with Milliman Care Guidelines (MCG) management.
• Experience with internal/external customer relations.
• Knowledge and familiarity of national accreditation standards, specifically NCQA and URAC standards.
• Bachelor’s degree.
• Utilization management experience.
• Health claims and mainframe system experience.

* *Reliable internet with hardwired ethernet connection is needed**

We encourage people of all backgrounds and experiences to apply.

Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

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.