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.

Job Summary

This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations.

Required Qualifications:

• Registered Nurse with current, active, unrestricted Registered Nurse (RN) license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.

• 3 years clinical experience.

• Verbal and written communications skills.

• Analytical and decision-making skills.

• Customer Service

Preferred Qualifications:

• Prior MRU experience

• NICU experience

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

Pay Transparency Statement:

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 https://careers.hcsc.com/totalrewards.

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.

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.

Base Pay Range

$61,500.00 - $136,100.00

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