field_remote_option

job_industry

field_job_occupational_field_parents_all

job_organization_name

job_upgrade_is_featured

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care. Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services.<p><b>JOB REQUIREMENTS</b><b>:</b></p><ul> <li><h2>LPN with valid, current, unrestricted clinical license in the state of operations.</h2></li> <li><h2>3 years of clinical experience in physician office, hospital, or surgical setting.</h2></li> <li><h2>Customer service oriented to assist internal/external customers.</h2></li> <li><h2>Verbal and written communication skills.</h2></li> <li><h2>Interpersonal skills and ability to be a team player.</h2></li> <li><h2>Willingness and ability to travel.</h2></li> <li><h2>Familiar with PC or database systems.</h2></li> <li><h2>Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.</h2></li> </ul><p><b>PREFERRED JOB REQUIREMENTS</b><b>:</b></p><ul> <li><h2>LPN / LVN Multi-state License Preferred</h2></li> <li><h2>Utilization review or utilization management experience</h2></li> <li><h2>Strong organizational, planning, and communication skills</h2></li> <li><h2>Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10)</h2></li> <li><h2>Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.</h2></li> </ul><h2><b>Work Schedule: Weekend Rotation and Holiday Rotation (2 holidays per year)</b></h2><h2> <i><b>This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. </b></i><br> </h2><p>#LI-DP1</p><p>#CA</p><p>#LI - REMOTE</p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$45,000.00 - $100,100.00

Blue Cross and Blue Shield of Oklahoma

Medical Reviewer LPN

Health Care Service Corporation

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>This position is responsible for performing concurrent review and case management activities in (discharge planning) in accordance with approved departmental guidelines. Collaboration with healthcare providers, members, and business partners to optimize member benefits with evaluation medical necessity and promote effective use of resources. Applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individual’s health needs.<p><b>JOB REQUIREMENTS:</b><br>Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.<br>3 years clinical practice experience.<br>1 year Health Insurance/Managed Care experience.<br>Knowledge of clinical utilization management/case management activities and standardized criteria set.<br>Knowledge of managed care and insurance industry.<br>Familiarity of ancillary services including HHC, SNF, Hospice, Etc.<br>Verbal and written communication skills; analytical skills; sound clinical judgment.<br>PC proficiency to include Microsoft Word, Excel and Access.<br>Current driver’s license.<br>Ability and willingness to travel.<br>Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.<br><br><b>PREFERRED JOB REQUIREMENTS:</b><br>Working toward CM certification or advanced degree.<br>Experience managing complex or catastrophic cases.<br>Experience in Disease Management.<br>Knowledge of Medical Management policies and procedures.<br>Familiarity with medical guidelines (M&amp;R, Interqual, etc.).<br>Preparation of cost analysis on extra contractual benefit requests.</p><p><b>Telecommute:</b><br>This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.</p><p>#LI-TELECOMMUTE</p><p>#LI-SG1</p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$60,300.00 - $133,400.00

Care Coordinator UM/CM II

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>This Position Is Responsible For Assisting With Leading The Team With All Divisional Short-Term And Long-Term Planning, Assisting The Leadership Team On Executing The Business Plan, Strategies, Analytics And Data Needs For The Division And Working With Divisional Leadership On Strategies And Business Plans For Functional Areas. Working With Enterprise Areas To Ensure There Is Alignment With The Divisional Strategy. Documenting And Conducting Analysis Of Competitive And Market Information For The Division And Ensuring Integration With Overall Strategy.<p><b>Required Job Qualifications:</b></p><ul> <li>Bachelor degree and 6 years experience in health care, health insurance, or strategic consulting environment OR Bachelor degree and 5 years consulting experience involving strategic planning, business development and financial management operations OR 8 years of experience strategic planning, market research, payment integrity, or product development in health care industry.</li> <li>Experience leading and formulating strategy with the ability to build strong connections with people and teams.</li> <li>Drive results by working across departments in matrixed environment.</li> <li>Interpersonal skills, including presentation, written and verbal communication.</li> <li>Experience with business analytics and information synthesis.</li> <li>Knowledge of strategic planning techniques and industry trends</li> <li>Able to work within a very fast-paced, quickly evolving organization and manage multiple, complex priorities.</li> <li>Work directly with corporate leadership.</li> <li>Analytical, program management and problem solving skills</li> </ul><p><b>Preferred Job Qualifications:</b></p><ul><li>Advanced degree such as Juris Doctor, MBA or MHA.</li></ul><p>This is a Flex (Hybrid) role: 3 days in office; 2 days remote.  .</p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$90,900.00 - $164,200.00

Principle Divisional Strategy Consultant

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>HCSC is looking for dynamic individuals to join its Executive Protection department! This position is responsible for the day-to-day operational protection and security logistics of key HCSC Senior Executives in various geographical areas. Additional protective activities may also extend to the HCSC Board of Directors, Senior Leadership Team, any persons designated by the CEO, or to other corporate business units and occasional domestic travel may be required. Duties will include but are not limited to physical protection, threat assessment and intelligence gathering, executive logistics and transportation, liaison with law enforcement officials, and maintaining regular contact with management. Incumbent will secure high-profile corporate individuals from potential threats and manage risks, assess danger levels, and plan secure routes for travel. NOTE: relocation will not be offered, sponsorship is not available ~<p><b>Required Job Qualifications: </b></p><ul> <li>Bachelor’s degree and 5 years of experience in law enforcement or the security and safety profession OR 9 years of experience in law enforcement or the security and safety profession.</li> <li>Excellent communication and interpersonal skills. Ability to deal with individuals at all levels within a large organization.</li> <li>Ability to deal effectively with law enforcement at all levels.</li> <li>Ability to analyze and prioritize tasks.</li> <li>Ability to work with high level corporate executives and their support teams.</li> <li>Ability to travel based on requirements of assigned executives.  </li> <li>A valid driver's license and clean driving record.</li> <li>Authorization to carry and use firearms. Currently hold a HR 218/ Law Enforcement Officer’s Safety Act certification.</li> <li>Strong physical fitness and the ability to meet physical demands of the role.</li> <li>Proficiency in threat assessment and risk management.</li> <li>Keen attention to detail and exceptional situational awareness.</li> <li>Strong discretion and the ability to handle sensitive information.</li> </ul><p><b>Preferred Job Qualifications: </b></p><ul> <li>Certified Protection Professional (CPP), Physical Security Professional (PSP), as certified by the American Society for Industrial Security (ASIS).</li> <li>CPR, AED, and first aid certification.</li> <li>Bachelor’s degree in criminal justice.</li> </ul><p> NOTE: relocation will not be offered, sponsorship is not available ~<br> </p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$69,200.00 - $146,700.00

Exec Protection Specialist

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>This is an opportunity for a motivated lawyer to provide counsel relating to complex matters relating to insurance regulatory filings, financial reporting, treasury support, corporate governance, subsidiary operations and transactions. This position provides guidance and support on insurance regulatory filings and requests and represents HCSC in dealing with trade organizations and regulators. In a highly complex and evolving legal and technology environment, the ideal candidate will provide sound, actionable legal advice on regulatory, business, and operational matters. A successful candidate will serve as a partner to our business leaders in developing adaptive strategies to support HCSC’s established business and to further its growth while continually advancing HCSC’s mission.<br><br>HCSC is the largest customer-owned health insurer in the United States, operating Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. In addition to its core health insurance offerings, HCSC is proud to serve millions of people through a diverse portfolio of businesses that provide adjacent products and services. These companies help advance HCSC’s goal of expanding access to quality, cost-effective health care to help people live healthier.<br><br>The position can be based in Chicago, Illinois; Richardson, Texas; Tulsa, Oklahoma; Albuquerque, New Mexico; Helena, Montana, or Nashville, Tennessee.<br><br>Please note this role is a hybrid role. This requires in-office hours 3 days a week at the respective office location.<br><br>Sponsorship is not available for this position.<p><b>JOB REQUIREMENTS</b><b>:</b></p><ul> <li><p>Juris Doctor Degree and a license to practice law in the state where the legal department is located.</p></li> <li><p>5 years experience as a practicing attorney after receiving a law degree.</p></li> <li><p>Demonstrated experience with insurance and healthcare regulations.</p></li> <li><p>Clear and concise verbal and written communication skills.</p></li> </ul><p><b>PREFERRED JOB REQUIREMENTS</b><b>:</b></p><ul> <li><p>Knowledge or understanding of the health care, health insurance, or claim administration field.</p></li> <li><p>3+ years’ experience advising providers, insurers, or other health care entities.</p></li> </ul><p>#LI-AZ1</p><p>#LI-HYBRID</p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$118,800.00 - $220,800.00

Assistant General Counsel - Corporate Regulatory

<p>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.</p><p>Join HCSC and be part of a purpose-driven company that will invest in your professional development.</p><h1><b>Job Summary</b></h1>This is an opportunity for a motivated lawyer to provide counsel relating to complex contracting, including vendor, provider network, producer/customer, and strategic sourcing contracting. In a highly complex and evolving legal and technology environment, the ideal candidate will provide sound, actionable legal advice on regulatory, business, and operational matters. A successful candidate will serve as a partner to our business leaders in developing adaptive strategies to support HCSC’s established business and to further its growth while continually advancing HCSC’s mission.<br><br>HCSC is the largest customer-owned health insurer in the United States, operating Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. In addition to its core health insurance offerings, HCSC is proud to serve millions of people through a diverse portfolio of businesses that provide adjacent products and services. These companies help advance HCSC’s goal of expanding access to quality, cost-effective health care to help people live healthier.<br><br>The position can be based in Chicago, Illinois; Richardson, Texas; Tulsa, Oklahoma; Albuquerque, New Mexico; Helena, Montana, or Nashville, Tennessee.<br>Please note this role is a hybrid role. This requires in-office hours 3 days a week at the respective office location.<br><br>Sponsorship is not available for this position.<p><b>JOB REQUIREMENTS</b><b>:</b></p><ul> <li><p>Juris Doctor Degree and a license to practice law in the state where the legal department is located.</p></li> <li><p>5 years’ experience as a practicing attorney after receiving a law degree.</p></li> <li><p>Clear and concise verbal and written communication skills.</p></li> </ul><p><b>PREFERRED JOB REQUIREMENTS</b><b>:</b></p><ul> <li><p>Knowledge or understanding of the health care, health insurance, or claim administration field.</p></li> <li><p>3+ years’ experience advising providers, insurers, or other health care entities.</p></li> </ul><p>#LI-AZ1</p><p>#LI-HYBRID</p><p><b>Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!</b></p><p><b>Pay Transparency Statement:</b></p><p>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 <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.</p><p>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.</p><h2>HCSC Employment Statement:</h2><p>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.</p><h1><b>Base Pay Range</b></h1>$118,800.00 - $220,800.00

11 Other Jobs in Helena, MT, USA