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Nurse Reviewer


This is a Full-time position in Dallas, TX posted January 18, 2023.

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

Innovation Lab (Dallas) — Helping Customers Reimagine the Purpose of Health Insurance
Opening in August 2017 in the West End, Innovation Lab is a high-rise development housing HCSC in the Heart of Dallas. This will be a place where we put our customers first while we imagine, explore, nurture, and activate on their behalf. This facility will serve as a beacon for customers to show them how committed we are to generating forward-thinking solutions that reduce health care expenses and improve health outcomes. It will complement existing functions and infuse innovation into our daily operations.

Case Management (Cm) And Disease Management (Dm). Is A Single Source Of Contact For Members, Health Care Personnel And All Other Entities Involved In Managing Care. The Primary Nurse Coordinator Performs Concurrent Review, Discharge Planning And Care Coordination. 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 Episodic Case Management, Determining Member Assignment Of Treatment, And Pre-Admission/Post-Discharge Counseling For An Acute Condition. Establish Relationship With The Member Through The Immediate Post Discharge Follow-Up Period 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, The Primary Nurse Coordinator 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.


* Registered Nurse (RN) with current, valid, unrestricted license in state of operations
* 2 years clinical practice experience of direct clinical care to the customer
* 1 year experience in Condition Management or Case 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
* Knowledge of UM/CM/DM activities and standardized criteria set
* Familiarity of ancillary services including HHC, SNF, Hospice, etc
* Verbal and written communication skills; analytical skills; sound clinical judgment
* 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.

* 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 certification or Advanced degree
* Knowledge of Milliman Guidelines or similar clinical guidelines
* Knowledge of medical management policies and procedures

• $7500 Sign on bonus

• Flex schedule (2 days remote work/week)

• The C1 Lab is located in the West End District Downtown Dallas, TX.

Thank you for your interest in the position. We look forward to reviewing your application. 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.

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