Case Administrator Coordinator

Spectraforce Technologies; Columbia (SC); Remote; USD 40,000 - 60,000; Full time

Job summary

An established industry player is seeking a dedicated Case Administrator Coordinator to enhance their healthcare operations. This role involves maintaining the outpatient authorization process, ensuring benefit coverage, and collaborating with medical management on complex cases. Ideal candidates will have a strong background in managed care and hold an active LPN/LVN license. Join a dynamic team of healthcare professionals committed to improving patient care and operational efficiency. This position offers the flexibility of remote work after initial onsite training, making it an exciting opportunity for those passionate about healthcare administration.

Qualifications

• 3 years experience in managed care, healthcare, or insurance.
• Active LPN/LVN licensure required.

Responsibilities

• Coordinate daily operations of assigned area in healthcare.
• Maintain outpatient authorization process and eligibility reviews.
• Document processes and decisions accurately and timely.

Skills

Managed Care Experience

Communication Skills

Utilization Review

Authorization Process

Education

Graduate of Accredited School of Licensed Practical Nursing

Tools

Microsoft Office

Job description

Role Name: Case Administrator Coordinator

Location: Columbia, SC 29229

Work Environment: Remote (After Onsite training)

Schedule: Mon to Fri, 6 am - 2:30pm OR 8:30 am - 5pm

Contract length: 3 months assignment with possible conversion



Job Summary:

Duties/About the role:

Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function.



Day to Day:

• 60% Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations. Completes authorization by following established policies/procedures.


• 20% Reviews interdepartmental requests and medical information to complete utilization process.


• 15% Documents process used and decision in the appropriate system in accurate/timely manner.


• 5% Establishes/maintains effective business relationships with primary care physician offices, other providers of health services.

Team Info: My team is a mix of RNs and LPNs, that review denied claims for all service types in healthcare.



Any extra/additional job info: NA



Job Requirements:

Required Experience: 3 years managed care in healthcare, physician's office, or insurance company setting.

Required EDU: Other Degree - Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing.

Required Certification or licenses: Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC).

Required Software and Tools (Hands on experience required): Microsoft Office

Soft skills: communication skills

Nice to have/Preferred skills: Any background with filing or reviewing appeals, post- service experience highly preferred. Background with billing and coding or claims review. Broad clinical background