Coordinator, Managed Care I

TALENT Software Services; Columbia (SC); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare solutions provider in Columbia, SC, seeks a qualified Registered Nurse to review clinical procedures and collaborate with team members. Responsibilities include assessing requests, determining approvals, and assisting colleagues as needed within a supportive work environment. The ideal candidate is flexible, organized, and possesses clear documentation skills. Enjoy a fulfilling career in a vibrant city known for its history, culture, and community.

Qualifications

• Must have an RN license as non-RN candidates will not be considered.
• Experience in hospital settings is required.
• Strong organizational skills and ability to work independently.

Responsibilities

• Review requested procedures against clinical criteria.
• Determine case approvals or referrals to the Medical Director.
• Assist teammates with their workloads.

Skills

Clear and concise documentation

Able to work autonomously

Flexible and adaptable

Strong team player

Education

RN License

Tools

Microsoft Office

Microsoft Excel

Microsoft Access

Job description

Responsibilities

• Review requested procedures against clinical criteria


• Determine:
  
  
  
  • Approval
  
  
  • Denial
  
  
  • Or referral to Medical Director
  
  
  
  


• Assist teammates with their queues when needed


• Must be flexible and collaborative


• Multiple job hopping


• Anything other than an RN license (Non-RN candidates will not be considered)


• Clear and concise documentation


• Well-organized


• Able to work autonomously


• Flexible and adaptable


• Willing to help others


• Strong team player

Typical Day in the Role

• Work from a case queue after training


• Review requested procedures against clinical criteria


• Determine:
  
  
  
  • Approval
  
  
  • Denial
  
  
  • Or referral to Medical Director
  
  
  
  


• Assist teammates with their queues when needed


• Must be flexible and collaborative

Not Looking For

• Zero hospital experience


• Multiple job hopping


• Anything other than an RN license (Non-RN candidates will not be considered)

Required Soft Skills

• Clear and concise documentation


• Well-organized


• Able to work autonomously


• Flexible and adaptable


• Willing to help others


• Strong team player

About the Team

• Tight-knit team that has worked together for a long time


• Handles precertification for outpatient procedures (office & hospital)


• Works closely with:
  
  
  
  • Concurrent nurses
  
  
  • Case management
  
  
  • Medical directors
  
  
  
  


• Has direct contact with:
  
  
  
  • Providers
  
  
  • Members
  
  
  
  

Required Software and Tools: Microsoft Office.

Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes.

Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access or other spreadsheet/database software.

Work Environment: Typical office environment. Employee may work from one's/out of one's home. May involve some travel within one's community.

Join our team in Columbia, SC

a vibrant city known for its rich history, diverse culture, and welcoming community. Enjoy a fulfilling career in a supportive environment while taking advantage of the city's numerous amenities and beautiful surroundings.