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.

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Job Summary

This position will be responsible as the HCM business owner of the Medical Necessity Source of Truth rules database for the enterprise. The owner will ensure that the database is kept in sync with all other internal PA/RCR rule sets and medical necessity review BITS as system integrations evolve to use this application as the single source. Will assist with troubleshooting defects, issues and discrepancies in data and rule coding. Will be accountable to work with project teams who have impact on PA rules to ensure that MNSOT is properly codified with any rule changes and ensure projects test changes in UAT and production when required. Responsible to code new rules and maintain rules in the database for the enterprise. Will be responsible to address questions and inquiries related to PA rule sets. Responsible to work across the enterprise and in collaboration with key stakeholders to socialize and train project teams and operational teams on the necessity to inform of rules changes. Establishes governance processes and business processes to request changes to rules and guides users through the execution of requests for changes.
This role fosters strong, ongoing relationships among internal and external business partners by leveraging their subject matter expertise and thought partnership, transferring knowledge, best practices (external and internal), methodology and tools. May be responsible for concurrent initiatives as team lead and/or team member, based on resource requirements.

This position is FLEX (3 days in the office)

• RN License

• Certified Coder

Required Job Qualifications:

• Bachelor’s Degree in Business, Healthcare or related field

• 4 years experience in strategic planning, program or product development, or market research

• Strong interpersonal, consultative and relationship building skills in order to initiate and develop productive working partnerships with all levels of management/leadership and staff

• Effective communication, written and negotiation skills, and ability to communicate and influence internal and external customers

Preferred Job Qualifications:

• Registered Nurse

• Certified Coder

• Knowledge and understanding of Utilization Management at HCSC, including our various systems and tools used to maintain PA rules and the impact of inaccuracies in rule coding.

• Technical skills in system configuration and documentation of PA rules

• Master’s Degree in Business, Healthcare or related field
  * Consulting experience
  * Health care/health insurance industry experience
  * New Program implementation experience
  * Strong Clinical Program experience with familiarity with clinical program delivery

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.